Healthcare Provider Details

I. General information

NPI: 1841432564
Provider Name (Legal Business Name): CECILIA LORRAINE CORDOVA CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORRAINE CECILIA CORDOVA-CARRIAGA CFNP

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 ISLETA BLVD SW
ALBUQUERQUE NM
87105-4634
US

IV. Provider business mailing address

4425 SAN ISIDRO ST NW
ALBUQUERQUE NM
87107-2840
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-8311
  • Fax: 866-265-6465
Mailing address:
  • Phone: 505-345-5887
  • Fax: 866-265-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR17186
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: