Provider Demographics
NPI:1194872861
Name:CORDERO, MARIO N (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:N
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:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-5040
Mailing Address - Country:US
Mailing Address - Phone:408-448-9211
Mailing Address - Fax:408-448-2743
Practice Address - Street 1:2030 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4833
Practice Address - Country:US
Practice Address - Phone:408-993-1814
Practice Address - Fax:408-993-1822
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34509207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942674488OtherEIN
CA942674488OtherEIN
CA942674488OtherEIN