Provider Demographics
NPI:1699203711
Name:CORDOVA, DALILA (NP)
Entity Type:Individual
Prefix:
First Name:DALILA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DALILA
Other - Middle Name:
Other - Last Name:CORDOVA VARELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:3915 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1200
Practice Address - Country:US
Practice Address - Phone:713-265-6955
Practice Address - Fax:833-845-2869
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134004363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty