Provider Demographics
NPI:1588732259
Name:CORDERO, REYNALDO MADRID (MD)
Entity type:Individual
Prefix:
First Name:REYNALDO
Middle Name:MADRID
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 1:350 POSADA LN
Mailing Address - Street 2:#102
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4059
Mailing Address - Country:US
Mailing Address - Phone:805-434-3699
Mailing Address - Fax:805-434-4864
Practice Address - Street 1:350 POSADA LN
Practice Address - Street 2:STE. 102
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4059
Practice Address - Country:US
Practice Address - Phone:805-434-3699
Practice Address - Fax:805-434-4864
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48713207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA48713DMedicare ID - Type Unspecified
CAE84360Medicare UPIN