Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 4175 | PR |
Y | 103TC0700X | Clinical Psychologist | 4175 | PR |
NPI | 1013051135 |
---|---|
Provider Name | Dr. Domingo B. Cordero |
First Address | Toa Baja, PR 00950-1519 |
Second Address | San Juan, PR 00907-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |