Provider Demographics
NPI:1205015872
Name:CORDOVA, VIOLETA CONSUELA
Entity Type:Individual
Prefix:
First Name:VIOLETA
Middle Name:CONSUELA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIOLETA
Other - Middle Name:CONSUELA
Other - Last Name:COR-DOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17171 ROSCOE BLVD APT 101E
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5246
Mailing Address - Country:US
Mailing Address - Phone:818-708-1429
Mailing Address - Fax:
Practice Address - Street 1:7533 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1949
Practice Address - Country:US
Practice Address - Phone:818-904-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health