Healthcare Provider Details

I. General information

NPI: 1265961650
Provider Name (Legal Business Name): HECTOR ALEJANDRO OLIVERAS CORDERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S COUNTY COMMONS WAY # 2
WAKEFIELD RI
02879-8271
US

IV. Provider business mailing address

15 LA SALLE SQ
PROVIDENCE RI
02903-1814
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-1004
  • Fax: 401-606-1153
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD21186
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: