MEDICARE: DR. SANTOS RUIZ 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
1	311Z00000X	Custodial Care Facility	ACN501	FL
2	208D00000X	General Practice Physician	ACN501	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1598976557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANTOS RUIZ CORDERO MD

Provider Business Mailing Address
First Line	:	1600 36TH ST STE C
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4875
Country	:	US
Telephone Number	:	772-217-4422
Fax Number	:	772-217-4460

Provider Business Practice Location Address
First Line	:	1600 36TH ST STE C
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4875
Country	:	US
Telephone Number	:	772-217-4422
Fax Number	:	772-217-4460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	11/07/2025

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