Healthcare Provider Details

I. General information

NPI: 1528748894
Provider Name (Legal Business Name): KARINA ELIZABETH CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

285 BETHANY DR
SCOTTS VALLEY CA
95066-2804
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: