Healthcare Provider Details

I. General information

NPI: 1164096574
Provider Name (Legal Business Name): KARLA CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

IV. Provider business mailing address

320 E PALMDALE BLVD
PALMDALE CA
93550-4598
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-3887
  • Fax: 818-957-5061
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1420050221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: