MEDICARE: RYANE MARIE CORDERO NP

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	363A00000X	Physician Assistant	PA06459	TX

General Provider Information

NPI Number	:	1629307509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYANE MARIE CORDERO NP

Provider Business Mailing Address
First Line	:	414 NAVARRO ST.
Second Line	:	STE #1401
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2534
Country	:	US
Telephone Number	:	210-579-3468
Fax Number	:	210-587-8145

Provider Business Practice Location Address
First Line	:	1139 E SONTERRA BLVD STE 205
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4349
Country	:	US
Telephone Number	:	210-874-3359
Fax Number	:

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

Provider Enumeration Date	:	12/23/2009
Last Update Date	:	11/27/2019

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