Provider Demographics
NPI:1316104748
Name:DR. DELFIN GINES CORDOVA & ASSOC INC
Entity type:Organization
Organization Name:DR. DELFIN GINES CORDOVA & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GINES MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-750-3390
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986-0092
Mailing Address - Country:US
Mailing Address - Phone:787-750-3390
Mailing Address - Fax:757-750-3390
Practice Address - Street 1:VILLA CAROLINA AVE CAMPO RICO
Practice Address - Street 2:BLQ 204 #1 5TA SECCION
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-750-3390
Practice Address - Fax:787-750-3390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7628305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE00150Medicare UPIN