Provider Demographics
NPI:1831610799
Name:CORDERO, NATALIA NOELIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:NOELIA
Last Name:CORDERO
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 1513
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1513
Mailing Address - Country:US
Mailing Address - Phone:787-459-7339
Mailing Address - Fax:
Practice Address - Street 1:78 CALLE CAIMAN
Practice Address - Street 2:BO SANTA ROSA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-459-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5778103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5778OtherJUNTA EXAMINADORA DE PSICOLOGOS
PR482290880OtherUNITED STATES DEPARTMENT OF STATE