MEDICARE: MRS. SUSET MARTINEZ CORDOVI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-26-89015	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104460302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSET MARTINEZ CORDOVI

Provider Business Mailing Address
First Line	:	7375 NW 173RD DR APT 101
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 NW 173RD DR APT 101
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-8428
Country	:	US
Telephone Number	:	305-898-0549
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	04/07/2026

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