Provider Demographics
NPI:1205866621
Name:CORDERO, MORGAN LEONIDES (MD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:LEONIDES
Last Name:CORDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 372278
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2278
Mailing Address - Country:US
Mailing Address - Phone:787-995-1313
Mailing Address - Fax:787-995-1313
Practice Address - Street 1:5 ST. BLOQUE 6 #27 SANTA ROSA
Practice Address - Street 2:NO.2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8815
Practice Address - Country:US
Practice Address - Phone:787-995-1313
Practice Address - Fax:787-995-1631
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11184208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88410OtherTRIPLE-S, INC
PR87604Medicare ID - Type Unspecified