Provider Demographics
NPI:1891011656
Name:CORDOVA, ASTRID E (LND)
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:E
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I-6 CALLE 7
Mailing Address - Street 2:EL MIRADOR
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-636-1400
Mailing Address - Fax:787-755-5777
Practice Address - Street 1:I-6 CALLE 7
Practice Address - Street 2:EL MIRADOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-636-1400
Practice Address - Fax:787-755-5777
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR948133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist