Healthcare Provider Details

I. General information

NPI: 1689759375
Provider Name (Legal Business Name): NORMA B CORNEJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WESTWARD DR
MIAMI SPRINGS FL
33166
US

IV. Provider business mailing address

215 WESTWARD DR
MIAMI SPRINGS FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 305-885-1792
  • Fax: 305-887-1475
Mailing address:
  • Phone: 305-885-1792
  • Fax: 305-887-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME25014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: