Basic Information
| Provider Information | |||||||||
| NPI: | 1063831691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORDEIRO | ||||||||
| FirstName: | SAMUEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 W SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917231515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587223185 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 S PACA ST | ||||||||
| Address2: | 6TH FLOOR SUITE 200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103288025 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2014 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | A145871 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.