Healthcare Provider Details

I. General information

NPI: 1053278499
Provider Name (Legal Business Name): ENMA LAIDA CORDERO-RODRIGUEZ PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5789 NW 151ST ST
MIAMI LAKES FL
33014-2424
US

IV. Provider business mailing address

10131 HAMMERLY BLVD
HOUSTON TX
77080-5014
US

V. Phone/Fax

Practice location:
  • Phone: 866-378-1547
  • Fax:
Mailing address:
  • Phone: 281-779-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044730
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1118434
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number409217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: