Provider Demographics
NPI:1922749605
Name:CORDOVA, MELISSA SUSANA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSANA
Last Name:CORDOVA
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 1:22115 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304
Mailing Address - Country:US
Mailing Address - Phone:818-884-8100
Mailing Address - Fax:818-884-7808
Practice Address - Street 1:22115 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304
Practice Address - Country:US
Practice Address - Phone:818-884-8100
Practice Address - Fax:818-884-7808
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist