NPI Code Detail JSON Logo

1669907259 NPI number — BENJAMIN CORDERO BERNARDO DPT

NPI Number: 1669907259
Health Care Provider/Practitioner: BENJAMIN CORDERO BERNARDO DPT

Information about “1669907259” NPI (BENJAMIN CORDERO BERNARDO DPT) exists in 1669907259 in HTML format HTML  |  1669907259 in plain Text format TXT  |  1669907259 in PDF (Portable Document Format) PDF  |  1669907259 in an XML format XML  formats.

NPI Number : 1669907259 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669907259",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERNARDO",
    "FirstName": "BENJAMIN",
    "MiddleName": "CORDERO",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6338 LAUREL CHERRY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCKFORD",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61108-1582",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5666 E STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROCKFORD",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61108-2425",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-395-5165",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/21/2017",
    "LastUpdateDate": "04/21/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "070009210",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.