Healthcare Provider Details

I. General information

NPI: 1700164308
Provider Name (Legal Business Name): CORDIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2011
Last Update Date: 07/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 W HADLEY ST
PHOENIX AZ
85009-5559
US

IV. Provider business mailing address

4205 N 7TH AVE SUITE 204
PHOENIX AZ
85013-3078
US

V. Phone/Fax

Practice location:
  • Phone: 602-368-1725
  • Fax:
Mailing address:
  • Phone: 602-368-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO DIAZ
Title or Position: PRESIDENT
Credential:
Phone: 480-280-0442