Provider Demographics
NPI:1659716504
Name:CORDOVA, CELINA VIANEY
Entity Type:Individual
Prefix:MRS
First Name:CELINA
Middle Name:VIANEY
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CELINA
Other - Middle Name:VIANEY
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4201
Mailing Address - Country:US
Mailing Address - Phone:559-264-7521
Mailing Address - Fax:559-441-0340
Practice Address - Street 1:2550 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4201
Practice Address - Country:US
Practice Address - Phone:559-264-7521
Practice Address - Fax:559-441-0340
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor