Provider Demographics
NPI:1275721151
Name:JENNIFER VALDES COCHRAN CSP
Entity Type:Organization
Organization Name:JENNIFER VALDES COCHRAN CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-642-1641
Mailing Address - Street 1:PO BOX 8806
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792
Mailing Address - Country:US
Mailing Address - Phone:787-705-9205
Mailing Address - Fax:787-705-9206
Practice Address - Street 1:URB MENDEZ A 2 SUITE 1
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-705-9205
Practice Address - Fax:787-705-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15471261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care