Provider Demographics
NPI:1578813879
Name:CORDOVA, ROCIO ELISABETH MENDOZA
Entity Type:Individual
Prefix:
First Name:ROCIO ELISABETH
Middle Name:MENDOZA
Last Name: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 1:3845 AVOCADO SCHOOL ROAD
Mailing Address - Street 2:DAY TREATMENT
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-752-3061
Mailing Address - Fax:
Practice Address - Street 1:3845 AVOCADO SCHOOL RD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7319
Practice Address - Country:US
Practice Address - Phone:619-752-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health