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NPI Code Detail

MEDICARE: DR. DIANA M CORDERO MD

MEDICARE:  DR. DIANA M CORDERO  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease PhysicianME0057227FL
2207R00000XInternal Medicine PhysicianME0057227FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00906112OTHERFLMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053357707
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA M CORDERO MD
Provider Business Mailing Address
First Line : 3720 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-3814
Country : US
Telephone Number : 904-475-2039
Fax Number : 904-330-0668
Provider Business Practice Location Address
First Line : 3720 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-3814
Country : US
Telephone Number : 904-475-2039
Fax Number : 904-330-0668
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 05/19/2016

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Directions to “ DR. DIANA M CORDERO MD” Practice Location

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