MEDICARE: LILI SANCHEZ-CORDOVA PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist
2	103TC0700X	Clinical Psychologist	PSY30651	CA
3	103T00000X	Psychologist	PSY30651	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023362167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILI SANCHEZ-CORDOVA PSY.D.

Provider Business Mailing Address
First Line	:	2447 PACIFIC COAST HWY STE 213
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	213-281-9384
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 PACIFIC COAST HWY STE 213
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2714
Country	:	US
Telephone Number	:	213-281-9384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	01/16/2019

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