Healthcare Provider Details

I. General information

NPI: 1891483137
Provider Name (Legal Business Name): MARIA T CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 W CARSON ST
TORRANCE CA
90502-2009
US

IV. Provider business mailing address

1237 W CARSON ST
TORRANCE CA
90502-2009
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-4534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number68793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: