Healthcare Provider Details

I. General information

NPI: 1689389686
Provider Name (Legal Business Name): NINEDTY CORDOVA MUNIZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 NW 27TH AVE STE 130
MIAMI FL
33125-2173
US

IV. Provider business mailing address

1490 NW 27TH AVE STE 130
MIAMI FL
33125-2173
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7710
  • Fax:
Mailing address:
  • Phone: 305-635-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11023623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: