Provider Demographics
NPI:1679883557
Name:CORNEJO, ERIKA S
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:S
Last Name:CORNEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13611 SKINNER RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1018
Mailing Address - Country:US
Mailing Address - Phone:832-593-6767
Mailing Address - Fax:832-593-6868
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1018
Practice Address - Country:US
Practice Address - Phone:832-593-6767
Practice Address - Fax:832-593-6868
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3287013-01Medicaid