Provider Demographics
NPI:1730291568
Name:GINES CORDOVA, DELFIN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DELFIN
Middle Name:
Last Name:GINES CORDOVA
Suffix:SR
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 92
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986
Mailing Address - Country:US
Mailing Address - Phone:787-685-0532
Mailing Address - Fax:787-750-3390
Practice Address - Street 1:435 ST BLOG 192
Practice Address - Street 2:#18 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-685-0532
Practice Address - Fax:787-750-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0027267Medicare PIN
E00150Medicare UPIN