Provider Demographics
NPI:1689009284
Name:CORDOVA, CRISTOBAL E (DPT)
Entity Type:Individual
Prefix:MR
First Name:CRISTOBAL
Middle Name:E
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MCCABE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5924
Mailing Address - Country:US
Mailing Address - Phone:775-788-5599
Mailing Address - Fax:775-788-5598
Practice Address - Street 1:15 MCCABE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5924
Practice Address - Country:US
Practice Address - Phone:775-788-5599
Practice Address - Fax:775-788-5598
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2730OtherLICENSE