Provider Demographics
NPI:1205058062
Name:CORDOBA-FABELO, MARTHA ROSA (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ROSA
Last Name:CORDOBA-FABELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 SOUTHWEST BLVD NO.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703
Mailing Address - Country:US
Mailing Address - Phone:727-526-7337
Mailing Address - Fax:727-528-7337
Practice Address - Street 1:431 SOUTHWEST BLVD NO
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703
Practice Address - Country:US
Practice Address - Phone:727-526-7337
Practice Address - Fax:727-528-7337
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100075208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics