Provider Demographics
NPI:1376212498
Name:CORDOVA, VICTORIA LYNETTE (MS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNETTE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CRAIG CIR # 12
Mailing Address - Street 2:
Mailing Address - City:RIO COMMUNITIES
Mailing Address - State:NM
Mailing Address - Zip Code:87002-6106
Mailing Address - Country:US
Mailing Address - Phone:505-315-3124
Mailing Address - Fax:
Practice Address - Street 1:2300 CANDELARIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2054
Practice Address - Country:US
Practice Address - Phone:505-658-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCF7524235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist