Provider Demographics
NPI:1881080125
Name:CORDERO-REYES, ANDREA M (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:CORDERO-REYES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2102 TREASURE HILLS BLVD
Mailing Address - Street 2:#3.144.05
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-1326
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:ML 0781
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-4505
Practice Address - Fax:513-584-0468
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2024-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10055733207R00000X
WI83770207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100280011Medicaid