Provider Demographics
NPI:1629012919
Name:CORDERO, ANTONIO BORROMEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:BORROMEO
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 1:1712 LILIHA ST.,
Mailing Address - Street 2:STE. 301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-536-1011
Mailing Address - Fax:808-545-3428
Practice Address - Street 1:1712 LILIHA ST.,
Practice Address - Street 2:STE. 301
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-536-1011
Practice Address - Fax:808-545-3428
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3931111NX0800X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI046551Medicaid
HI04655101Medicaid
HI04655101Medicaid
HID36101Medicare UPIN