Provider Demographics
NPI:1134190655
Name:CORDERO, JULIO D
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:D
Last Name:CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VEREDAS
Mailing Address - Street 2:VEREDAS DE LOS CEDROS 698
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-6098
Mailing Address - Country:US
Mailing Address - Phone:787-743-1985
Mailing Address - Fax:787-744-6276
Practice Address - Street 1:CARR 931 KM 5.4
Practice Address - Street 2:BO. NAVARRO SECTOR CIELITO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-743-1985
Practice Address - Fax:787-744-6276
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16022208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
16022OtherLICENCIA