Healthcare Provider Details

I. General information

NPI: 1366382285
Provider Name (Legal Business Name): JANESSA CORDOBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S KRAEMER BLVD STE 136
PLACENTIA CA
92870-6190
US

IV. Provider business mailing address

101 S KRAEMER BLVD STE 136
PLACENTIA CA
92870-6190
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-6503
  • Fax:
Mailing address:
  • Phone: 949-273-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number28815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: