Healthcare Provider Details

I. General information

NPI: 1598676520
Provider Name (Legal Business Name): SKYLER RAY CORDOVA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E SHEA BLVD STE 200
PHOENIX AZ
85028-3348
US

IV. Provider business mailing address

3420 E SHEA BLVD STE 200
PHOENIX AZ
85028-3348
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-3288
  • Fax:
Mailing address:
  • Phone: 602-675-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberAZ006033
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: