Provider Demographics
NPI:1477658946
Name:MANGUAL-CORDERO, EFREN EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:EDUARDO
Last Name:MANGUAL-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 660
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-0660
Mailing Address - Country:US
Mailing Address - Phone:787-255-6632
Mailing Address - Fax:787-255-6632
Practice Address - Street 1:MUNOZ RIVERA STREET
Practice Address - Street 2:34 BAJOS
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-309-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR126112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry