Coral Sand, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

AL9375 Issued in FL

Legal business name

CORAL SAND, INC.

Practice address

7800 Abbott Avenue
Miami Beach, FL 33141-2022

Phone

(305) 867-3232

Fax

(305) 867-9894

NPI assigned

Jan 26, 2015

Last updated

Jan 14, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Cardoso

Title

Owner

Phone

(786) 246-7300

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1720478001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7800 ABBOTT AVENUE",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331412022",
            "telephone_number": "305-867-3232",
            "fax_number": "305-867-9894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7800 ABBOTT AVENUE",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331412022",
            "telephone_number": "305-867-3232",
            "fax_number": "305-867-9894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL SAND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-26",
        "last_updated": "2025-01-14",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "CARDOSO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-246-7300"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "FL",
            "license": "AL9375",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142404100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Carlos Ernesto Cordero, M.D.
• Shelly Gretzinger Cordisco, ARNP
• Jose Mariano Cordova, APRN

• Assisted Living Facility (Mental Illness) in Miami Beach, FL
• Providers in Miami Beach, FL by specialty
• Assisted Living Facility (Mental Illness) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.