Provider Demographics
NPI:1164072377
Name:HERNANDEZ CORDERO, MOISES AMET (DC)
Entity Type:Individual
Prefix:
First Name:MOISES
Middle Name:AMET
Last Name:HERNANDEZ CORDERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13627 BALTIMORE AVE # 4
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5095
Mailing Address - Country:US
Mailing Address - Phone:301-708-0888
Mailing Address - Fax:301-431-0010
Practice Address - Street 1:13627 BALTIMORE AVE # 4
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5095
Practice Address - Country:US
Practice Address - Phone:301-708-0888
Practice Address - Fax:301-431-0010
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor