Provider Demographics
NPI:1982913489
Name:CORDERO, KARI ANNE
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ANNE
Last Name:CORDERO
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 1:470 CHADBOURNE RD STE E
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9620
Mailing Address - Country:US
Mailing Address - Phone:707-425-9670
Mailing Address - Fax:707-425-9880
Practice Address - Street 1:470 CHADBOURNE RD STE E
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9620
Practice Address - Country:US
Practice Address - Phone:707-425-9670
Practice Address - Fax:707-425-9880
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA632809163WP0808X
CA95001624363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health