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NPI Code Detail

MEDICARE: MR. ERANIO GARCHITORENA CORDOVA JR. LCSW

MEDICARE: MR. ERANIO GARCHITORENA CORDOVA JR. LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS29182CA

General Provider Information

NPI Number : 1386768489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERANIO GARCHITORENA CORDOVA JR. LCSW
Provider Business Mailing Address
First Line : 948 N MOHAWK AVE
Second Line :
City : ANAHEIM
State : CA
Zip : 92801-3508
Country : US
Telephone Number : 714-776-8840
Fax Number :
Provider Business Practice Location Address
First Line : 6301 BEACH BLVD STE 245
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-4031
Country : US
Telephone Number : 714-736-0231
Fax Number : 714-736-0895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 05/01/2018

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