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NPI Code Detail

MEDICARE: BESSY CORDOVA MA

MEDICARE: BESSY CORDOVA MA
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1760806129
Entity Type Code : Individual
Provider Name (Legal Business Name) : BESSY CORDOVA MA
Provider Business Mailing Address
First Line : 11030 HARTSOOK ST APT 224
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91601-3848
Country : US
Telephone Number : 661-312-6746
Fax Number :
Provider Business Practice Location Address
First Line : 6305 WOODMAN AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-2346
Country : US
Telephone Number : 818-908-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2014
Last Update Date : 02/05/2014

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Directions to “ BESSY CORDOVA MA” Practice Location

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