Active NPI
Enrique Cordova III
- Behavior Technician
- Sanford, FL
National Provider Identifier
1457123192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-303966
- Practice address
- 319 S Park Ave
Sanford, FL 32771 - Phone
- (407) 895-0801
- NPI assigned
- Oct 26, 2023
- Last updated
- Sep 13, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-303966 | FL | Primary |
Addresses
Primary practice location
319 S Park Ave
Sanford, FL 32771
Mailing address
1016 Cox CT
Oviedo, FL 32765-7067
Phone (407) 768-5452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-303966 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1457123192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 COX CT",
"city": "OVIEDO",
"state": "FL",
"postal_code": "327657067",
"telephone_number": "407-768-5452"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 S PARK AVE",
"city": "SANFORD",
"state": "FL",
"postal_code": "32771",
"telephone_number": "407-895-0801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "ENRIQUE",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-26",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-23-303966",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sanford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.