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General NPI Number Information
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NPI Number | 1629561873
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Entity Type | Individual
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Provider Name | HANIET CORDOVI MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 600 NE 22ND TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-4707
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Country | US
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Telephone | 786-668-3342
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Fax |
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Provider Business Mailing Address
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Address Line | 157 NE 25TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-6215
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Country | US
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Telephone | 305-951-9823
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9257883
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 19977
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN1078
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License Number State | FL
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