Provider Demographics
NPI:1962716530
Name:CODRE, MARIA C
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:CODRE
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 1:2831 RINGLING BLV#113D
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237
Mailing Address - Country:US
Mailing Address - Phone:941-726-1024
Mailing Address - Fax:
Practice Address - Street 1:2831 RINGLING BLVD STE 113D
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5363
Practice Address - Country:US
Practice Address - Phone:941-726-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist