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NPI Code Detail

MEDICARE: SASHA NICOLE CORDOVA

MEDICARE: SASHA NICOLE CORDOVA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1588170930
Entity Type Code : Individual
Provider Name (Legal Business Name) : SASHA NICOLE CORDOVA
Provider Business Mailing Address
First Line : 904 MOUNTAIN LION CIR STE 500
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-5725
Country : US
Telephone Number : 800-345-0448
Fax Number :
Provider Business Practice Location Address
First Line : 904 MOUNTAIN LION CIR STE 500
Second Line :
City : HARKER HEIGHTS
State : TX
Zip : 76548-5725
Country : US
Telephone Number : 800-345-0448
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2017
Last Update Date : 12/21/2017

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Directions to “ SASHA NICOLE CORDOVA ” Practice Location

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