Provider Demographics
NPI:1750931218
Name:CORDOVA, MARIANA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:B
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20832 SAN SIMEON WAY APT 60B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1808
Mailing Address - Country:US
Mailing Address - Phone:813-438-6709
Mailing Address - Fax:
Practice Address - Street 1:7420 6TH AVE NW
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-1531
Practice Address - Country:US
Practice Address - Phone:813-438-6709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10579103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist