Provider Demographics
NPI:1598092439
Name:CORDOVA, AMADA LUCIA
Entity Type:Individual
Prefix:MRS
First Name:AMADA
Middle Name:LUCIA
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 1:12832 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-3437
Mailing Address - Country:US
Mailing Address - Phone:708-743-3932
Mailing Address - Fax:
Practice Address - Street 1:12832 WOOD ST
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-3437
Practice Address - Country:US
Practice Address - Phone:708-743-3932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC63101248751171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter