Provider Demographics
NPI:1447957808
Name:CORDERO LOPEZ, ELIEZER (MD, PA)
Entity type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:CORDERO LOPEZ
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 45604
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9646
Mailing Address - Country:US
Mailing Address - Phone:787-519-9998
Mailing Address - Fax:
Practice Address - Street 1:MED CARIBE IPA 514
Practice Address - Street 2:AVE. ROOSEVELT 1028
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-706-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000451-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant