Provider Demographics
NPI:1417219437
Name:GADRINAB-JONES, KRYSTLE CORDOVA (MD)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:CORDOVA
Last Name:GADRINAB-JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N EOLA RD STE D
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9505
Mailing Address - Country:US
Mailing Address - Phone:630-646-6250
Mailing Address - Fax:
Practice Address - Street 1:1222 N EOLA RD STE D
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502
Practice Address - Country:US
Practice Address - Phone:630-646-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135982207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine