Healthcare Provider Details

I. General information

NPI: 1447782487
Provider Name (Legal Business Name): SARAH CORDOVA KUPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. SARAH RENEE CORDOVA

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 E INVERNESS AVE BLDG 3
MESA AZ
85206-4630
US

IV. Provider business mailing address

PO BOX 30388 CREDENTIALING DEPT
MESA AZ
85275-0388
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-3900
  • Fax: 480-830-3901
Mailing address:
  • Phone: 480-830-3900
  • Fax: 480-830-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberDR.0069466
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL20367
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number75883
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: