Provider Demographics
NPI:1619437886
Name:CORDOVA, PATRICIA (BCABA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BLANCO CIR STE C
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4450
Mailing Address - Country:US
Mailing Address - Phone:786-269-1227
Mailing Address - Fax:831-998-7682
Practice Address - Street 1:915 BLANCO CIR STE C
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4450
Practice Address - Country:US
Practice Address - Phone:786-269-1227
Practice Address - Fax:831-998-7682
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-19-10158106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst