=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881395747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORDERO HEALTH PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2023
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8500 SW 92ND ST STE 102
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-235-3700
-----------------------------------------------------
Fax | 786-235-3701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 654734
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33265-4734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-235-3700
-----------------------------------------------------
Fax | 786-235-3701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. ALEJANDRO A. CORDERO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-235-3700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------