Basic Information
| Provider Information | |||||||||
| NPI: | 1861854234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDERO | ||||||||
| FirstName: | WILSON | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10704 | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007320704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9392655102 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 CALLE GUADALUPE PISO 2 | ||||||||
| Address2: | INSPIRA PONCE | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877094130 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | 56777P | PR | Y | Nursing Service Related Providers | Technician | Personal Care Attendant |
No ID Information.