Provider Demographics
NPI:1447585237
Name:CORDERO, MARIELLA
Entity Type:Individual
Prefix:
First Name:MARIELLA
Middle Name:
Last Name:CORDERO
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 1:7109 HALRAY AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2017
Mailing Address - Country:US
Mailing Address - Phone:562-881-9032
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4366
Practice Address - Country:US
Practice Address - Phone:562-864-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable