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General NPI Number Information
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NPI Number | 1841187192
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Entity Type | Individual
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Provider Name | PRISCILLA MARIE CORDOVA
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Gender | Female
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1115 S SUNSET AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3940
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Country | US
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Telephone | 626-814-2534
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 W CALLE DEL SOL APT 4
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City | AZUSA
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State | CA
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Zip | 91702-1640
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Country | US
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Telephone | 626-391-0406
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Fax |
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN95368142
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | RN95368142
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | RN95368142
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN95368142
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License Number State | CA
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