Provider Demographics
NPI:1194221416
Name:REY CORDOBA, KENIA
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:REY CORDOBA
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 1:9064 COLLINS AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3253
Mailing Address - Country:US
Mailing Address - Phone:786-532-7052
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:9064 COLLINS AVE APT 9
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3253
Practice Address - Country:US
Practice Address - Phone:786-532-7052
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician