Provider Demographics
NPI: | 1639320856 |
---|---|
Name: | CORDOBA CARRILLO, CLAUDIA (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CLAUDIA |
Middle Name: | |
Last Name: | CORDOBA CARRILLO |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | CLAUDIA |
Other - Middle Name: | |
Other - Last Name: | CORDOBA-CARRILLO |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 21 URB LAS NUBES |
Mailing Address - Street 2: | |
Mailing Address - City: | CAGUAS |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00727-3150 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-601-4552 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 5102 URB SERENNA |
Practice Address - Street 2: | LOS PRADOS |
Practice Address - City: | CAGUAS |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00727-3308 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-601-4552 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2008-10-07 |
Last Update Date: | 2016-02-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 27277 | 207R00000X |
PR | 18324 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |