Provider Demographics
NPI:1699497081
Name:CORDERO, JOEL DANIEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:DANIEL
Last Name:CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S 333RD ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7357
Mailing Address - Country:US
Mailing Address - Phone:253-766-5156
Mailing Address - Fax:
Practice Address - Street 1:720 S 333RD ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7357
Practice Address - Country:US
Practice Address - Phone:253-766-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110000767297Medicaid