Provider Demographics
NPI:1932651320
Name:CORDOVA, MONICA (MS, ATC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 QUINCY AVE APT B
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-1818
Mailing Address - Country:US
Mailing Address - Phone:562-650-0641
Mailing Address - Fax:
Practice Address - Street 1:13406 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4446
Practice Address - Country:US
Practice Address - Phone:562-907-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000087102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer