Provider Demographics
NPI:1700815685
Name:CORDERO, HECTOR DE JESUS (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:DE JESUS
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 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3000
Mailing Address - Fax:
Practice Address - Street 1:1090 6TH AVE N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5604
Practice Address - Country:US
Practice Address - Phone:239-213-9200
Practice Address - Fax:239-213-9205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09990208000000X
FLME94236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME94236OtherMEDICAL LISENCE
FL276436900Medicaid
RIMD09990OtherMEDICAL LISENCE
RIMD09990OtherMEDICAL LISENCE
RI379002793Medicare ID - Type Unspecified