Provider Demographics
NPI:1629307509
Name:CORDERO, RYANE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:RYANE
Middle Name:MARIE
Last Name:CORDERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NAVARRO ST.
Mailing Address - Street 2:STE #1401
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2534
Mailing Address - Country:US
Mailing Address - Phone:210-579-3468
Mailing Address - Fax:210-587-8145
Practice Address - Street 1:1139 E SONTERRA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4349
Practice Address - Country:US
Practice Address - Phone:210-874-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant