Provider Demographics
NPI:1679032171
Name:CORDOVA, MARGARITA LISA (LMT 9121)
Entity Type:Individual
Prefix:MISS
First Name:MARGARITA
Middle Name:LISA
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:LMT 9121
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1417 LUCRETIA ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-7995
Mailing Address - Country:US
Mailing Address - Phone:505-227-6961
Mailing Address - Fax:
Practice Address - Street 1:9204 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2256
Practice Address - Country:US
Practice Address - Phone:505-883-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM9121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist