1396321873 NPI number — DAVID ENRIQUE CORDERO CORONADO

Table of content: DAVID ENRIQUE CORDERO CORONADO (NPI 1396321873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396321873 NPI number — DAVID ENRIQUE CORDERO CORONADO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDERO CORONADO
Provider First Name:
DAVID
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396321873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1711 WEST BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
BRITISH COLUMBIA
Provider Business Mailing Address Postal Code:
V6J 1Y2
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1711 WEST BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
BRITISH COLUMBIA
Provider Business Practice Location Address Postal Code:
V6J 1Y2
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
647-997-6830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175F00000X , with the licence number:  NT61108921 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com