Active NPI
Maridely Cordero, LND
- Nutritionist
- San Sebastian, PR
National Provider Identifier
1720467616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 1596
- Practice address
- 66 Calle MJ Cabrero
San Sebastian, PR 00685-4843 - Phone
- (787) 452-2200
- NPI assigned
- May 25, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 1596 | PR | Primary |
Addresses
Primary practice location
66 Calle MJ Cabrero
San Sebastian, PR 00685-4843
Mailing address
HC 7 Box 76350
San Sebastian, PR 00685-7366
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160112002773 | PR | Practitioner - Registered Dietitian Or Nutrition Professional | 2062714736 | Practice locations: San Sebastian, PR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1596 | PR | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720828800000",
"number": "1720467616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 7 BOX 76350",
"city": "SAN SEBASTIAN",
"state": "PR",
"postal_code": "006857366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 CALLE MJ CABRERO",
"city": "SAN SEBASTIAN",
"state": "PR",
"postal_code": "006854843",
"telephone_number": "787-452-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDERO",
"first_name": "MARIDELY",
"credential": "LND",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-25",
"last_updated": "2024-07-13",
"certification_date": "2024-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "PR",
"license": "1596",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Sebastian, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.