Provider Demographics
NPI:1760480180
Name:CORDERO, NIZETTE I (RPT)
Entity type:Individual
Prefix:
First Name:NIZETTE
Middle Name:I
Last Name:CORDERO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO MARQUEZ
Mailing Address - Street 2:CALLE 9 G-26
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-0000
Mailing Address - Country:US
Mailing Address - Phone:787-898-5885
Mailing Address - Fax:787-898-5885
Practice Address - Street 1:CARR. 129 KM 13.6
Practice Address - Street 2:BO. BAYANEY
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-898-5885
Practice Address - Fax:787-898-5885
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2007-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89222OtherTRIPLE-S (REFORMA)
PR89243Medicare ID - Type UnspecifiedCMS/MEDICARE
PR89222OtherTRIPLE-S (REFORMA)