Provider Demographics
NPI:1255938593
Name:CORDERO LOPEZ, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:CORDERO LOPEZ
Suffix:
Gender:F
Credentials:
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 3842
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3842
Mailing Address - Country:US
Mailing Address - Phone:787-362-8600
Mailing Address - Fax:
Practice Address - Street 1:300 CALLE MENDEZ VIGO OESTE
Practice Address - Street 2:ESQUINA MANUEL PIRALLO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-831-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6632103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty