Provider Demographics
NPI:1083980031
Name:RISQUEZ CORDOVEZ, CRISTOBAL FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:CRISTOBAL FERNANDO
Middle Name:
Last Name:RISQUEZ CORDOVEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CRISTOBAL
Other - Middle Name:FERNANDO
Other - Last Name:RISQUEZ CORDOVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 562435
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-2435
Mailing Address - Country:US
Mailing Address - Phone:786-299-5419
Mailing Address - Fax:844-431-6801
Practice Address - Street 1:7000 SW 97TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1474
Practice Address - Country:US
Practice Address - Phone:786-299-5419
Practice Address - Fax:844-431-6801
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150756207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME150756OtherSTATE LICENSE