Provider Demographics
NPI:1003130162
Name:CORDOVA, PAULA VICTORIA (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:VICTORIA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1307
Mailing Address - Country:US
Mailing Address - Phone:415-261-1164
Mailing Address - Fax:
Practice Address - Street 1:250 EXECUTIVE PARK BLVD
Practice Address - Street 2:SUITE 4900
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-3394
Practice Address - Country:US
Practice Address - Phone:415-656-0116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist