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NPI Code Detail

MEDICARE: DERRICK V CORDERO

MEDICARE: DERRICK V CORDERO
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1235954934
Entity Type Code : Individual
Provider Name (Legal Business Name) : DERRICK V CORDERO
Provider Business Mailing Address
First Line : 2997 REDWOOD PKWY
Second Line :
City : VALLEJO
State : CA
Zip : 94591-3636
Country : US
Telephone Number : 707-567-8945
Fax Number :
Provider Business Practice Location Address
First Line : 2101 COURAGE DR
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6717
Country : US
Telephone Number : 707-754-8505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2024
Last Update Date : 01/12/2026

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