Provider Demographics
NPI:1215259627
Name:CORICA, FEDERICO ALBERTO (MD)
Entity type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:ALBERTO
Last Name:CORICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2908
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2908
Mailing Address - Country:US
Mailing Address - Phone:787-866-2732
Mailing Address - Fax:787-866-2732
Practice Address - Street 1:2435 BLVD LUIS A FERRE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2112
Practice Address - Country:US
Practice Address - Phone:787-866-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17818208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology