Provider Demographics
NPI:1295143758
Name:ORTIZ CORDERO, GLORYMAR (MD)
Entity type:Individual
Prefix:DR
First Name:GLORYMAR
Middle Name:
Last Name:ORTIZ CORDERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 15133
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-7945
Mailing Address - Country:US
Mailing Address - Phone:787-637-1373
Mailing Address - Fax:
Practice Address - Street 1:BO MONACILLO CENTRO MEDICO DE PUERTO RICO
Practice Address - Street 2:HOSPITAL SAN JUAN DEPT DE PEDIATRIA 3ER NIVEL
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-637-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31113-R390200000X
PR019508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program