Provider Demographics
NPI:1033622238
Name:CORDEIRO, RHIANNON (RDHAP)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 PANAMINT ROW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2817
Mailing Address - Country:US
Mailing Address - Phone:619-829-8479
Mailing Address - Fax:
Practice Address - Street 1:6832 PANAMINT ROW UNIT 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-2817
Practice Address - Country:US
Practice Address - Phone:619-829-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27974124Q00000X
CA810124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist