Provider Demographics
NPI:1205357076
Name:CORUJO, BERTHA (RN)
Entity type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:
Last Name:CORUJO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 NW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3625
Mailing Address - Country:US
Mailing Address - Phone:305-775-6056
Mailing Address - Fax:
Practice Address - Street 1:935 NW 15TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3625
Practice Address - Country:US
Practice Address - Phone:305-775-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3170112163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology