Provider Demographics
NPI:1104460302
Name:MARTINEZ CORDOVI, SUSET
Entity type:Individual
Prefix:MRS
First Name:SUSET
Middle Name:
Last Name:MARTINEZ CORDOVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3285 NW 211TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1003
Mailing Address - Country:US
Mailing Address - Phone:786-898-0549
Mailing Address - Fax:
Practice Address - Street 1:3285 NW 211TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1003
Practice Address - Country:US
Practice Address - Phone:786-898-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician