Provider Demographics
NPI:1316008378
Name:ASTUDILLO-CORDOVA, JUAN ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRES
Last Name:ASTUDILLO-CORDOVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11234 ANDERSON ST
Mailing Address - Street 2:HOUSE STAFF OFFICE CP 21005
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2804
Mailing Address - Country:US
Mailing Address - Phone:909-558-8131
Mailing Address - Fax:909-558-0430
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:HOUSE STAFF OFFICE, CP 21005
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-8131
Practice Address - Fax:909-558-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106781208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery