Healthcare Provider Details

I. General information

NPI: 1831514678
Provider Name (Legal Business Name): MRS. HEATHER MARIE CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 ACADEMY RD NE SUITE C
ALBUQUERQUE NM
87111
US

IV. Provider business mailing address

PO BOX 663
PLACITAS NM
87043-0663
US

V. Phone/Fax

Practice location:
  • Phone: 505-350-9483
  • Fax:
Mailing address:
  • Phone: 505-350-9483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: