Provider Demographics
NPI:1073253738
Name:CORDOVA, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 E MAYO BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5182
Mailing Address - Country:US
Mailing Address - Phone:480-563-9966
Mailing Address - Fax:833-953-0022
Practice Address - Street 1:7025 E MAYO BLVD STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5182
Practice Address - Country:US
Practice Address - Phone:480-563-9966
Practice Address - Fax:833-953-0022
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1718175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath