Healthcare Provider Details

I. General information

NPI: 1386470854
Provider Name (Legal Business Name): YADIRA LOPEZ CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 STATE ST APT 8
SANTA BARBARA CA
93101-2537
US

IV. Provider business mailing address

1628 STATE ST APT 8
SANTA BARBARA CA
93101-2537
US

V. Phone/Fax

Practice location:
  • Phone: 805-705-7304
  • Fax:
Mailing address:
  • Phone: 805-705-7304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: