1760903504 NPI number — GIOVANNI GERARDO CORDOBA SOLIS MD

Table of content: GIOVANNI GERARDO CORDOBA SOLIS MD (NPI 1760903504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760903504 NPI number — GIOVANNI GERARDO CORDOBA SOLIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDOBA SOLIS
Provider First Name:
GIOVANNI
Provider Middle Name:
GERARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760903504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4422 THIRD AVENUE
Provider Second Line Business Mailing Address:
THIRD FLOOR, MILLS BUILDING
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-933-0441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4422 3RD AVE FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-933-0441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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