Provider Demographics
NPI:1003517459
Name:CORDAL, LIDIA ESTHER
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:ESTHER
Last Name:CORDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16130 SW 107TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2970
Mailing Address - Country:US
Mailing Address - Phone:305-741-8686
Mailing Address - Fax:
Practice Address - Street 1:144 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4328
Practice Address - Country:US
Practice Address - Phone:786-410-9806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician