Healthcare Provider Details

I. General information

NPI: 1639998834
Provider Name (Legal Business Name): PAOLA CORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 POTTSVILLE PIKE STE 101B
READING PA
19605-9707
US

IV. Provider business mailing address

103 DELTA CT
WERNERSVILLE PA
19565-1645
US

V. Phone/Fax

Practice location:
  • Phone: 484-578-9796
  • Fax:
Mailing address:
  • Phone: 610-621-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC001217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: