Provider Demographics
NPI:1730657479
Name:CORDERO, LOURDES FRANCESCA (MED, PSYD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:FRANCESCA
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MED, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 CALLE ZARAGOZA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4013
Mailing Address - Country:US
Mailing Address - Phone:787-702-4677
Mailing Address - Fax:
Practice Address - Street 1:914 CALLE ZARAGOZA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4013
Practice Address - Country:US
Practice Address - Phone:787-702-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PROCESS390200000X
PR006759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program