Pedro Rafael Cordova Amador Sr., MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

22006 Issued in PR

Practice address

PR- 111 KM 14.6, Bo. Hato Arriba
San Sebastian, PR 00685

Phone

(939) 699-6177

Fax

(939) 699-6176

NPI assigned

Sep 23, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1083220198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 CHALETS DE LA PLAYA",
            "city": "VEGA BAJA",
            "state": "PR",
            "postal_code": "006939748",
            "telephone_number": "787-975-6000",
            "fax_number": "787-699-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PR- 111 KM 14.6, BO. HATO ARRIBA",
            "city": "SAN SEBASTIAN",
            "state": "PR",
            "postal_code": "00685",
            "telephone_number": "939-699-6177",
            "fax_number": "939-699-6176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORDOVA AMADOR",
        "first_name": "PEDRO",
        "middle_name": "RAFAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-23",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "22006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Consultorio de Medicina Interna CSP
• Consultorio de Medicina Interna CSP
• Maritza Cordero Gonzalez, OTR/L
• Nashalie Zoe Cordero Valentin
• Maridely Cordero, LND
• Betsy Soto Cortes
• Yesenia Cruz Morales, MA
• Linnette Cruz Pena, MSPT
• Jesus I Cruz Ramos, MSW
• Wanda I Cruz Rosa, DPT

• General Practice Physician in San Sebastian, PR
• Providers in San Sebastian, PR by specialty
• General Practice Physician in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.