Healthcare Provider Details

I. General information

NPI: 1861848103
Provider Name (Legal Business Name): MICHELLE CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W WALNUT ST # 375
PASADENA CA
91124-7102
US

IV. Provider business mailing address

8357 LEXINGTON GALLATIN RD
PICO RIVERA CA
90660-5128
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-534-5938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106H00000X
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: