Healthcare Provider Details

I. General information

NPI: 1568847978
Provider Name (Legal Business Name): CORDELIA KPADUWA NURSE PRACTITIONER P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13622 DEARBORN ST
EASTVALE CA
92880-5504
US

IV. Provider business mailing address

7340 FLORENCE AVE STE 219
DOWNEY CA
90240-3672
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-8006
  • Fax: 562-928-8261
Mailing address:
  • Phone: 562-928-8006
  • Fax: 562-928-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021209235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: