Healthcare Provider Details

I. General information

NPI: 1063613354
Provider Name (Legal Business Name): JENNIFER R CORDIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S OAK AVE SUITE A1
OAKDALE CA
95361-3572
US

IV. Provider business mailing address

440 AIRPORT BLVD
SALINAS CA
93905-3302
US

V. Phone/Fax

Practice location:
  • Phone: 209-848-8133
  • Fax:
Mailing address:
  • Phone: 831-757-0434
  • Fax: 831-757-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA104461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: