Provider Demographics
NPI:1518948892
Name:CORDERO, GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:CORDERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 VERDE MAR UNIT C
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-5743
Mailing Address - Country:US
Mailing Address - Phone:904-629-1542
Mailing Address - Fax:904-629-1542
Practice Address - Street 1:649 VERDE MAR UNIT C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-5743
Practice Address - Country:US
Practice Address - Phone:904-629-1542
Practice Address - Fax:904-629-1542
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025476207P00000X
CAA80815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051527865Medicaid
AL051527865OtherBCBS PROVIDER NUMBER
AL051527865Medicare PIN
AL051527865OtherBCBS PROVIDER NUMBER
AL051527865Medicaid
CAAZ227TMedicare PIN