Healthcare Provider Details

I. General information

NPI: 1902263304
Provider Name (Legal Business Name): NORMA B. CORNEJO, M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WESTWARD DR
MIAMI SPRINGS FL
33166-5259
US

IV. Provider business mailing address

215 WESTWARD DR
MIAMI SPRINGS FL
33166-5259
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. NORMA B CORNEJO
Title or Position: OWNER
Credential: M.D.
Phone: 305-885-1792