Healthcare Provider Details

I. General information

NPI: 1700815685
Provider Name (Legal Business Name): HECTOR DE JESUS CORDERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 6TH AVE N
NAPLES FL
34102-5604
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142-2200
US

V. Phone/Fax

Practice location:
  • Phone: 239-213-9200
  • Fax: 239-213-9205
Mailing address:
  • Phone: 239-658-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD09990
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: