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General NPI Number Information
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NPI Number | 1205058062
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Entity Type | Individual
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Provider Name | MARTHA ROSA CORDOBA-FABELO MD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 11/06/2017
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Provider Practice Location Address
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Address Line | 431 SOUTHWEST BLVD NO
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City | ST PETERSBURG
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State | FL
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Zip | 33703
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Country | US
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Telephone | 727-526-7337
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Fax | 727-528-7337
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Provider Business Mailing Address
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Address Line | 431 SOUTHWEST BLVD NO.
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City | ST. PETERSBURG
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State | FL
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Zip | 33703
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Country | US
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Telephone | 727-526-7337
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Fax | 727-528-7337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME100075
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License Number State | FL
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