Provider Demographics
NPI:1205974607
Name:MARIA CORDOVA & ASSOC. PA
Entity type:Organization
Organization Name:MARIA CORDOVA & ASSOC. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-432-1532
Mailing Address - Street 1:4577 WESTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3141
Mailing Address - Country:US
Mailing Address - Phone:954-432-1532
Mailing Address - Fax:
Practice Address - Street 1:4577 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3141
Practice Address - Country:US
Practice Address - Phone:954-432-1532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2957332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC2957OtherOPTOMETRIC LICENSE