Basic Information
| Provider Information | |||||||||
| NPI: | 1265961650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVERAS CORDERO | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | ALEJANDRO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 CALLE BROMELIAS | ||||||||
| Address2: | URB. SAN RAFAEL ESTATES | ||||||||
| City: | BAYAMON | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009594171 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | AV AMERICO MIRANDA S/N SAN JUAN 00935 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 01/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 15236 | PR | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 15236 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.