Provider Demographics
NPI:1386380582
Name:MANGUAL, JOSUE CORDERO SR (BSN)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:CORDERO
Last Name:MANGUAL
Suffix:SR
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO QUEBRADA ARENAS SECTOR LA LOMA #15 CAMINO MANGUAL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-585-8341
Mailing Address - Fax:
Practice Address - Street 1:BO QUEBRADA ARENAS SECTOR LA LOMA #15 CAMINO MANGUAL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-585-8341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)