Basic Information
| Provider Information | |||||||||
| NPI: | 1497806319 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANA SEDA CORDERO, CSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 RD. KM. 58.0 | ||||||||
| Address2: | TIERRA SANTA | ||||||||
| City: | VILLALBA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878473778 | ||||||||
| FaxNumber: | 7878471305 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 RD. KM. 58.0 | ||||||||
| Address2: | TIERRA SANTA | ||||||||
| City: | VILLALBA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878473778 | ||||||||
| FaxNumber: | 7878471305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | SEDA CORDERO | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878473778 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 11458 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.