Provider Demographics
NPI:1649317082
Name:DR. MARIA A. CORDOVA & ASSOC., PA
Entity type:Organization
Organization Name:DR. MARIA A. 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 1:11401 PINES BLVD
Mailing Address - Street 2:SUITE 352
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4117
Mailing Address - Country:US
Mailing Address - Phone:954-432-1532
Mailing Address - Fax:
Practice Address - Street 1:11401 PINES BLVD
Practice Address - Street 2:SUITE 352
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4117
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:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2957152W00000X, 152WS0006X
FLOPC02957152WC0802X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC2957OtherOPTOMETRIC LICENSE