Provider Demographics
NPI:1205681103
Name:CORDERO JORGE, DANIA
Entity type:Individual
Prefix:
First Name:DANIA
Middle Name:
Last Name:CORDERO JORGE
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 1:10780 N PRESERVE WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6575
Mailing Address - Country:US
Mailing Address - Phone:786-834-8057
Mailing Address - Fax:
Practice Address - Street 1:10780 N PRESERVE WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6575
Practice Address - Country:US
Practice Address - Phone:786-834-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-340907106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician