Healthcare Provider Details

I. General information

NPI: 1821849837
Provider Name (Legal Business Name): KIMBERLY CORDOVA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6798
US

IV. Provider business mailing address

PO BOX 981
TEMPLE CITY CA
91780-0981
US

V. Phone/Fax

Practice location:
  • Phone: 833-542-2273
  • Fax:
Mailing address:
  • Phone: 626-704-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: