Provider Demographics
NPI:1699491449
Name:CORDOVE DE LA CRUZ, GEYDI BERNALDINA (CBHCM)
Entity type:Individual
Prefix:
First Name:GEYDI
Middle Name:BERNALDINA
Last Name:CORDOVE DE LA CRUZ
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:GEYDI
Other - Middle Name:B
Other - Last Name:CORDOVE DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5716
Mailing Address - Country:US
Mailing Address - Phone:786-226-5289
Mailing Address - Fax:
Practice Address - Street 1:975 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5716
Practice Address - Country:US
Practice Address - Phone:786-226-5289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM103901104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker