MEDICARE: MRS. CYNTHIA ORTIZ-CORREA ST

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	235Z00000X	Speech-Language Pathologist	SA6524	FL

General Provider Information

NPI Number	:	1144361353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA ORTIZ-CORREA ST

Provider Business Mailing Address
First Line	:	17900 NW 5TH ST
Second Line	:	SUITE 103
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-2809
Country	:	US
Telephone Number	:	954-435-9905
Fax Number	:	954-435-3769

Provider Business Practice Location Address
First Line	:	17900 NW 5TH ST
Second Line	:	SUITE 103
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-2809
Country	:	US
Telephone Number	:	954-435-9905
Fax Number	:	954-435-3769

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. CYNTHIA ORTIZ-CORREA ST” Practice Location

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