Provider Demographics
NPI:1831269893
Name:CORDOVES-MARCHESE, RAQUEL I (RD LDN)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:I
Last Name:CORDOVES-MARCHESE
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:I
Other - Last Name:CORDOVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:544 MANATEE BAY DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2801
Mailing Address - Country:US
Mailing Address - Phone:561-870-2142
Mailing Address - Fax:888-276-5007
Practice Address - Street 1:544 MANATEE BAY DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2801
Practice Address - Country:US
Practice Address - Phone:561-870-2142
Practice Address - Fax:888-276-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3415133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL838837OtherNATIONAL REGISTRATION #
FLND3415OtherSTATE LICENSE