Provider Demographics
NPI:1740538099
Name:CORDONERO, LYDIA IRIS (MSW INTERN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:IRIS
Last Name:CORDONERO
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 ELSTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1141
Mailing Address - Country:US
Mailing Address - Phone:415-933-2945
Mailing Address - Fax:
Practice Address - Street 1:3761 ELSTON DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1141
Practice Address - Country:US
Practice Address - Phone:415-933-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program