Provider Demographics
NPI:1336285584
Name:CORNEJO, ROSA
Entity Type:Individual
Prefix:PROF
First Name:ROSA
Middle Name:
Last Name:CORNEJO
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 1:1601 NW 12TH AVE
Mailing Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS PROGRAM
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-5600
Mailing Address - Fax:305-243-4595
Practice Address - Street 1:1601 NW 12TH AVE
Practice Address - Street 2:UNIVERSITY OF MIAMI EARLY STEPS PROGRAM
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-243-5600
Practice Address - Fax:305-243-4595
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7678142Medicaid