Provider Demographics
NPI:1427622216
Name:CORDERO-DOMENECH, MYRNARIS (DC)
Entity type:Individual
Prefix:
First Name:MYRNARIS
Middle Name:
Last Name:CORDERO-DOMENECH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 CASSIA CIR APT H
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2820
Mailing Address - Country:US
Mailing Address - Phone:787-457-7153
Mailing Address - Fax:
Practice Address - Street 1:450 W STATE ROAD 434 STE 2030
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5187
Practice Address - Country:US
Practice Address - Phone:321-999-7311
Practice Address - Fax:321-341-1199
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor