Provider Demographics
NPI:1548807407
Name:CORDOBA SABORIO, MARIANELA (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:CORDOBA SABORIO
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 NW 30TH WAY
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8391
Mailing Address - Country:US
Mailing Address - Phone:561-703-1403
Mailing Address - Fax:954-606-5293
Practice Address - Street 1:3014 NW 30TH WAY
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33311-8391
Practice Address - Country:US
Practice Address - Phone:561-703-1403
Practice Address - Fax:954-606-5293
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15192171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty