Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS7420 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | OS7420 | FL |
NPI | 1407856685 |
---|---|
Provider Name | Dr. Marlene Tages Cordova |
First Address | Pembroke Pines, FL 33026-5207 |
Second Address | Pembroke Pines, FL 33026-5207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G51841 | (02) | FL |