Healthcare Provider Details

I. General information

NPI: 1982498978
Provider Name (Legal Business Name): KEVIN ONEL SALAS CORDERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 MACO DR
HARLINGEN TX
78550-8450
US

IV. Provider business mailing address

349 S HELEN MOORE RD APT 1203
SAN BENITO TX
78586-9086
US

V. Phone/Fax

Practice location:
  • Phone: 956-296-1519
  • Fax:
Mailing address:
  • Phone: 939-209-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10100869
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number61352125
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: