Provider Demographics
NPI:1376530279
Name:LADO-CORNEJO, CARLOS A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:LADO-CORNEJO
Suffix:
Gender:M
Credentials:PHD
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 2921
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2921
Mailing Address - Country:US
Mailing Address - Phone:787-403-4259
Mailing Address - Fax:787-841-4170
Practice Address - Street 1:54 CALLE TENERIFE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1462
Practice Address - Country:US
Practice Address - Phone:787-403-4259
Practice Address - Fax:787-841-4170
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR02334103G00000X
PR2334103TC0700X
NMPSY1507103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100453OtherCRUZ AZUL
PR56737LAOtherTRIPLE S
PR219027OtherPREFERED HEALTH PLAN
PR2585OtherMMM
PR4153-5OtherPROSSAM
PR66-0642685OtherWELLPOINT BEHAVIORAL CARE
PR66-0642685OtherPREFERED MEDICAL CHOICE
PR66-0642685OtherFIRST MEDICAL
PR2584OtherREFORMA DE SALUD
PR66-0642685OtherMCS
PR518224OtherFHC-MCS EAP
PR66-0642685OtherCOSVI
PR7000007247OtherREMITENTE DE MEDICARE
PR2572OtherHUMANA GOLD PLAN
PR2572OtherHUMANA PPO/HMO
PR660642685OtherMSC CLASSICARE