Basic Information
Provider Information
NPI: 1124202510
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CORDERO
FirstName: HECTOR
MiddleName: ALEJANDRO
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: EXT. QUINTAS DE MONSERRATE CALLE 6 # 15
Address2:  
City: PONCE
State: PR
PostalCode: 00731
CountryCode: US
TelephoneNumber: 7872981920
FaxNumber:  
Practice Location
Address1: CALLE DEGETAU
Address2: HOSPITAL HIMA SAN PABLO
City: CAGUAS
State: PR
PostalCode: 00725
CountryCode: US
TelephoneNumber: 7876533434
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/21/2007
LastUpdateDate: 12/21/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X16986PRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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