Basic Information
| Provider Information | |||||||||
| NPI: | 1073637401 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWIN CORDERO MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9350 SUNSET DRIVE | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052740780 | ||||||||
| FaxNumber: | 3052749531 | ||||||||
| Practice Location | |||||||||
| Address1: | 9350 SUNSET DRIVE | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052740780 | ||||||||
| FaxNumber: | 3052749531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | CORDERO | ||||||||
| AuthorizedOfficialFirstName: | EDWIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3052740780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 255912900 | 05 | FL | MEDICAID |