Provider Demographics
NPI:1982847133
Name:EUNICE CORDOBA MDPA
Entity Type:Organization
Organization Name:EUNICE CORDOBA MDPA
Other - Org Name:TRUE MIND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-687-5837
Mailing Address - Street 1:12959 PALMS WEST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4937
Mailing Address - Country:US
Mailing Address - Phone:305-803-9887
Mailing Address - Fax:
Practice Address - Street 1:12959 PALMS WEST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4937
Practice Address - Country:US
Practice Address - Phone:305-803-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EUNICE CORDOBA MDPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 921492084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty