Provider Demographics
NPI:1881269496
Name:CORDOVEZ, MARIANELA
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:CORDOVEZ
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 1:2870 31ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-4476
Mailing Address - Country:US
Mailing Address - Phone:239-784-4007
Mailing Address - Fax:
Practice Address - Street 1:5432 RATTLESNAKE HAMMOCK RD FL 34113
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7454
Practice Address - Country:US
Practice Address - Phone:239-316-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician