1427758572 NPI number — MISS ORQUIDIA ESMERALDA CORDOVA

Table of content: MISS ORQUIDIA ESMERALDA CORDOVA (NPI 1427758572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427758572 NPI number — MISS ORQUIDIA ESMERALDA CORDOVA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORDOVA
Provider First Name:
ORQUIDIA
Provider Middle Name:
ESMERALDA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427758572
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14980 BLEEKER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLMAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91342-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-635-0599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FERNANDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91340-2957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-256-2206
Provider Business Practice Location Address Fax Number:
818-361-3210
Provider Enumeration Date:
03/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 512113 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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