Provider Demographics
NPI:1821671454
Name:VICTOR CORDOVA PSY.D A PSYCHOLOGICAL CORP.
Entity Type:Organization
Organization Name:VICTOR CORDOVA PSY.D A PSYCHOLOGICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-922-2442
Mailing Address - Street 1:9033 BASELINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1214
Mailing Address - Country:US
Mailing Address - Phone:909-922-2442
Mailing Address - Fax:909-999-2377
Practice Address - Street 1:9033 BASELINE RD STE A
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1214
Practice Address - Country:US
Practice Address - Phone:909-922-2442
Practice Address - Fax:909-999-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty