1952900839 NPI number — MRS. YIPSIA MAYRELIS CORDOVI CANCIO TCM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952900839 NPI number — MRS. YIPSIA MAYRELIS CORDOVI CANCIO TCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDOVI CANCIO
Provider First Name:
YIPSIA
Provider Middle Name:
MAYRELIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
TCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952900839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3837 SW 79TH AVE APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-6755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-587-4821
Provider Business Mailing Address Fax Number:
305-614-8255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3837 SW 79TH AVE APT A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-6755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-587-4821
Provider Business Practice Location Address Fax Number:
305-614-8255
Provider Enumeration Date:
10/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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