Provider Demographics
NPI:1225862824
Name:BORREGO CORDERO, GEISY AMANDA
Entity type:Individual
Prefix:
First Name:GEISY
Middle Name:AMANDA
Last Name:BORREGO 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 1:17341 SW 119TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2216
Mailing Address - Country:US
Mailing Address - Phone:305-528-4389
Mailing Address - Fax:
Practice Address - Street 1:17341 SW 119TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2216
Practice Address - Country:US
Practice Address - Phone:305-528-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-367467106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician