Healthcare Provider Details

I. General information

NPI: 1033857248
Provider Name (Legal Business Name): VANESSA CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date: 09/26/2023
Reactivation Date: 11/17/2023

III. Provider practice location address

12425 PARAMOUNT BLVD APT 104
DOWNEY CA
90242-3750
US

IV. Provider business mailing address

878 W 190TH ST STE 1000
GARDENA CA
90248
US

V. Phone/Fax

Practice location:
  • Phone: 562-507-9194
  • Fax:
Mailing address:
  • Phone: 310-329-9115
  • Fax: 877-394-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: