Provider Demographics
NPI:1043587819
Name:CORDOVA, ROBERT (NP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 QUIET SANDS DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3800
Mailing Address - Country:US
Mailing Address - Phone:562-225-1231
Mailing Address - Fax:
Practice Address - Street 1:1100 NORTH STATE STREET
Practice Address - Street 2:CLINIC TOWER A4A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:562-225-1231
Practice Address - Fax:323-441-8143
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily