=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427622216
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYRNARIS CORDERO-DOMENECH DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2021
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 MARCIA DR
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32714-2913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-378-6081
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 924 N MAGNOLIA AVE STE 202
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32803-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-457-7153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH13540
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------