Healthcare Provider Details

I. General information

NPI: 1831308154
Provider Name (Legal Business Name): EDWIN CORDERO, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 SW 72ND ST STE 112
MIAMI FL
33173-3245
US

IV. Provider business mailing address

9350 SW 72ND ST SUITE 112
MIAMI FL
33173-3286
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-0780
  • Fax: 888-781-7177
Mailing address:
  • Phone: 305-274-0780
  • Fax: 888-781-7177

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: OWNER
Credential: M.D.
Phone: 305-274-0780