Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A060160 | CA |
Y | 208600000X | Surgeon | A060160 | CA |
NPI | 1003822347 |
---|---|
Provider Name | Dr. Raymund S Cordero |
First Address | Wildomar, CA 92595-7512 |
Second Address | Wildomar, CA 92595-7512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 29/05/2012 |