Healthcare Provider Details

I. General information

NPI: 1376076752
Provider Name (Legal Business Name): GENIL NOEMI HERNANDEZ-DE CORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GENIL H CORA M.D.

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 MILLHAVEN DR
COPLEY OH
44321-1753
US

IV. Provider business mailing address

1149 MILLHAVEN DR
COPLEY OH
44321-1753
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-1232
  • Fax: 330-294-4219
Mailing address:
  • Phone: 330-665-1232
  • Fax: 330-294-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35078157
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: