Provider Demographics
NPI:1386854834
Name:AKO, CORENTINE ARIMBOH (MD)
Entity Type:Individual
Prefix:
First Name:CORENTINE
Middle Name:ARIMBOH
Last Name:AKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORENTINE
Other - Middle Name:ARIMBOH
Other - Last Name:KWENDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3350 SW 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:469-798-0711
Mailing Address - Fax:210-495-0343
Practice Address - Street 1:3350 SW 148TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:469-798-0711
Practice Address - Fax:210-495-0343
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
TXN1375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program