Provider Demographics
NPI:1558014381
Name:CAMPOS CORDERO, ANGELICA ANAIS
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:ANAIS
Last Name:CAMPOS CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CALLE LOTO
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9000
Mailing Address - Country:US
Mailing Address - Phone:787-519-1166
Mailing Address - Fax:
Practice Address - Street 1:205 CALLE LOTO
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-9000
Practice Address - Country:US
Practice Address - Phone:787-519-1166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22619208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice