Healthcare Provider Details

I. General information

NPI: 1376229765
Provider Name (Legal Business Name): MARIANA CORDON RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 CRESTVIEW CIR
WESTON FL
33327-1847
US

IV. Provider business mailing address

849 CRESTVIEW CIR
WESTON FL
33327-1847
US

V. Phone/Fax

Practice location:
  • Phone: 754-275-7923
  • Fax:
Mailing address:
  • Phone: 754-275-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number22-602
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9629609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: