Healthcare Provider Details

I. General information

NPI: 1033043401
Provider Name (Legal Business Name): ALEC CORDOBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13505 JULIAN DR
DESERT HOT SPRINGS CA
92240-5733
US

IV. Provider business mailing address

13505 JULIAN DR
DESERT HOT SPRINGS CA
92240-5733
US

V. Phone/Fax

Practice location:
  • Phone: 760-902-0953
  • Fax:
Mailing address:
  • Phone: 760-902-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number75202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: