Provider Demographics
NPI:1629875513
Name:CORDOBA, CARMEN (MSN, RN, NP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CORDOBA
Suffix:
Gender:F
Credentials:MSN, RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2002
Mailing Address - Country:US
Mailing Address - Phone:559-265-3000
Mailing Address - Fax:
Practice Address - Street 1:15218 W WHITESBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1000
Practice Address - Country:US
Practice Address - Phone:559-843-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12583363L00000X
CA526741163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner