Provider Demographics
NPI:1447074117
Name:CORDERO, BRYAN VEGA (DC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:VEGA
Last Name:CORDERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 31795
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9772
Mailing Address - Country:US
Mailing Address - Phone:787-223-6453
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 31795
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9772
Practice Address - Country:US
Practice Address - Phone:787-223-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor