Healthcare Provider Details

I. General information

NPI: 1982569653
Provider Name (Legal Business Name): STEPHANIE CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S GLENOAKS BLVD
BURBANK CA
91502-1319
US

IV. Provider business mailing address

400 HAUSER BLVD APT 12F
LOS ANGELES CA
90036-5524
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-5120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: