Provider Demographics
NPI:1326577511
Name:CORDERO, RIGOBERTO
Entity Type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:
Last Name:CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7376 NW 35TH TER STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1241
Mailing Address - Country:US
Mailing Address - Phone:305-477-6750
Mailing Address - Fax:
Practice Address - Street 1:7376 NW 35TH TER STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1241
Practice Address - Country:US
Practice Address - Phone:305-477-6750
Practice Address - Fax:305-477-6750
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-1648567OtherWORKERS COMPENSATION