Provider Demographics
NPI:1861074148
Name:OQUENDO CORDERO, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OQUENDO CORDERO
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 1:14155 NE 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3006
Mailing Address - Country:US
Mailing Address - Phone:786-444-8581
Mailing Address - Fax:
Practice Address - Street 1:14155 NE 16TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3006
Practice Address - Country:US
Practice Address - Phone:786-444-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-152177106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician