Provider Demographics
NPI:1447801089
Name:CORDOVA, PATRICIA (RDH, BS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3433 E FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6251
Mailing Address - Country:US
Mailing Address - Phone:602-541-1005
Mailing Address - Fax:
Practice Address - Street 1:4315 N MARYVALE PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1942
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:623-691-1770
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH008453124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist