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NPI Code Detail

MEDICARE: ROBIN CORDOVA

MEDICARE: ROBIN 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
1225000000XOrthotic Fitter

General Provider Information

NPI Number : 1740479179
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN CORDOVA
Provider Business Mailing Address
First Line : 3663 N LAUGHLIN RD STE 103
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-9067
Country : US
Telephone Number : 707-528-7999
Fax Number :
Provider Business Practice Location Address
First Line : 3663 N LAUGHLIN RD STE 103
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-9067
Country : US
Telephone Number : 707-528-7999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2007
Last Update Date : 09/22/2009

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Directions to “ ROBIN CORDOVA ” Practice Location

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