Provider Demographics
NPI:1356301444
Name:HERNANDEZ CORDERO, RENE E (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:E
Last Name:HERNANDEZ CORDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0368
Mailing Address - Country:US
Mailing Address - Phone:787-877-0133
Mailing Address - Fax:787-877-0133
Practice Address - Street 1:232 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-0133
Practice Address - Fax:787-877-0133
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83048Medicare ID - Type Unspecified
PRF64266Medicare UPIN