Provider Demographics
NPI:1366627556
Name:RODRIGUEZ CORDOVA, FABIOLA
Entity Type:Individual
Prefix:MS
First Name:FABIOLA
Middle Name:
Last Name:RODRIGUEZ 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 1:20101 HAMILTON AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1306
Mailing Address - Country:US
Mailing Address - Phone:310-817-2177
Mailing Address - Fax:
Practice Address - Street 1:20101 HAMILTON AVE STE 160
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1306
Practice Address - Country:US
Practice Address - Phone:310-817-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90686106H00000X
CA57163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1366627556OtherMASADA HOMES