Provider Demographics
NPI:1609112598
Name:CORNIDEZ, FRANCISCO JAVIER (RBT)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
Last Name:CORNIDEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 NORTHUP WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1471
Mailing Address - Country:US
Mailing Address - Phone:425-822-6442
Mailing Address - Fax:425-828-3101
Practice Address - Street 1:3003 NORTHUP WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1471
Practice Address - Country:US
Practice Address - Phone:425-822-6442
Practice Address - Fax:425-828-3101
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-15-07950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC2752675OtherDRUG ENFORCEMENT ADMINISTRATION