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General NPI Number Information
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NPI Number | 1821671454
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Entity Type | Organization
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Legal Business Name | VICTOR CORDOVA PSY.D A PSYCHOLOGICAL CORP.
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Dates
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Enumeration Date | 05/02/2021
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Last Update Date | 05/02/2021
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Provider Practice Location Address
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Address Line | 9033 BASELINE RD STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1214
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Country | US
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Telephone | 909-922-2442
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Fax | 909-999-2377
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Provider Business Mailing Address
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Address Line | 9033 BASELINE RD STE A
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-1214
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Country | US
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Telephone | 909-922-2442
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Fax | 909-999-2377
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR CORDOVA
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Credential | PSY.D
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Telephone | 909-922-2442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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