Provider Demographics
NPI:1679606420
Name:CORNELL, LUZ MARINA (PHD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:MARINA
Last Name:CORNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 E COUNTY DOWN DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7342
Mailing Address - Country:US
Mailing Address - Phone:954-205-3186
Mailing Address - Fax:
Practice Address - Street 1:2925 E RIGGS RD
Practice Address - Street 2:# 8-207
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3600
Practice Address - Country:US
Practice Address - Phone:954-205-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3848103TC0700X
FLPY5470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184412OtherAHCCCS PROVIDER NUMBER