Provider Demographics
NPI:1902210966
Name:CORDERO, LYZMAR (LND)
Entity Type:Individual
Prefix:MRS
First Name:LYZMAR
Middle Name:
Last Name:CORDERO
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 1:201 CALLE TETUAN # 8
Mailing Address - Street 2:OLD SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1816
Mailing Address - Country:US
Mailing Address - Phone:787-410-3947
Mailing Address - Fax:
Practice Address - Street 1:201 CALLE TETUAN # 8
Practice Address - Street 2:OLD SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1816
Practice Address - Country:US
Practice Address - Phone:787-410-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1634133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered