Provider Demographics
NPI:1609194992
Name:CORDOVES, VIVIAN E (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:E
Last Name:CORDOVES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25312 MAWSON DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5244
Mailing Address - Country:US
Mailing Address - Phone:949-837-4048
Mailing Address - Fax:
Practice Address - Street 1:1016 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7462
Practice Address - Country:US
Practice Address - Phone:949-760-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist