Provider Demographics
NPI:1336671148
Name:CORDERO, NINA CAROLA (DMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:CAROLA
Last Name:CORDERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CALLE TULIPA
Mailing Address - Street 2:ESTANCIAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3640
Mailing Address - Country:US
Mailing Address - Phone:787-367-3736
Mailing Address - Fax:
Practice Address - Street 1:540 CALLE TULIPA
Practice Address - Street 2:ESTANCIAS DE TORTUGUERO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-367-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32581223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program