MEDICARE: MRS. SILVIANA CORDOVA AA CHILD DEVELOPMENT

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1679760656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SILVIANA CORDOVA AA CHILD DEVELOPMENT

Provider Business Mailing Address
First Line	:	4309 LEIMERT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5201
Country	:	US
Telephone Number	:	323-293-6000
Fax Number	:	323-293-6005

Provider Business Practice Location Address
First Line	:	4309 LEIMERT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-5201
Country	:	US
Telephone Number	:	323-293-6000
Fax Number	:	323-293-6005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/03/2007

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