Healthcare Provider Details

I. General information

NPI: 1184389314
Provider Name (Legal Business Name): SANDRA CORDERO RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 SW 56TH AVE
CORAL GABLES FL
33134-1070
US

IV. Provider business mailing address

575 SW 56TH AVE
CORAL GABLES FL
33134-1070
US

V. Phone/Fax

Practice location:
  • Phone: 786-237-1966
  • Fax:
Mailing address:
  • Phone: 786-237-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-83084
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-81673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: