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General NPI Number Information
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NPI Number | 1710295423
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Entity Type | Individual
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Provider Name | MARIA I CORDOVA - GONZALEZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 209 E 7TH ST
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City | MADERA
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State | CA
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Zip | 93638-3780
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Country | US
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Telephone | 559-673-3508
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Fax |
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Provider Business Mailing Address
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Address Line | 289 GREAT RD STE G1
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City | ACTON
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State | MA
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Zip | 01720-4766
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Country | US
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Telephone | 978-679-1200
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Fax | 978-486-4037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A166630
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 266938
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20819
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License Number State | PR
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