MEDICARE: MRS. YIPSIA MAYRELIS CORDOVI CANCIO TCM

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1952900839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YIPSIA MAYRELIS CORDOVI CANCIO TCM

Provider Business Mailing Address
First Line	:	3837 SW 79TH AVE APT A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6755
Country	:	US
Telephone Number	:	786-587-4821
Fax Number	:	305-614-8255

Provider Business Practice Location Address
First Line	:	3837 SW 79TH AVE APT A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6755
Country	:	US
Telephone Number	:	786-587-4821
Fax Number	:	305-614-8255

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

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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