Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 13899 | PR |
NPI | 1043277726 |
---|---|
Provider Name | Dr. Julio Cesar Cordero Pupo |
First Address | Aguadilla, PR 00603 |
Second Address | Aguada, PR 00602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 21/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H81009 | (02) | PR |