Healthcare Provider Details

I. General information

NPI: 1073637401
Provider Name (Legal Business Name): EDWIN CORDERO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 SUNSET DRIVE SUITE 112
MIAMI FL
33173
US

IV. Provider business mailing address

9350 SUNSET DRIVE SUITE 112
MIAMI FL
33173
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-0780
  • Fax: 305-274-9531
Mailing address:
  • Phone: 305-274-0780
  • Fax: 305-274-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN CORDERO
Title or Position: CEO
Credential: MD
Phone: 305-274-0780