Healthcare Provider Details

I. General information

NPI: 1922522820
Provider Name (Legal Business Name): ROXANNE CORDOVA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/13/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 E WALNUT ST STE 117
PASADENA CA
91106-5129
US

IV. Provider business mailing address

7975 ORLANDO DR
RIVERSIDE CA
92503-3015
US

V. Phone/Fax

Practice location:
  • Phone: 626-773-4364
  • Fax:
Mailing address:
  • Phone: 323-440-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108503
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: