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NPI Code Detail

MEDICARE: SAMUEL E CORDIVIN R.T.

MEDICARE: SAMUEL E CORDIVIN R.T.
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
12471C3402XRadiography Radiologic Technologist15727AZ

General Provider Information

NPI Number : 1770888281
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL E CORDIVIN R.T.
Provider Business Mailing Address
First Line : 3860 E SIOUX DR
Second Line : 11A
City : FLAGSTAFF
State : AZ
Zip : 86001-6668
Country : US
Telephone Number : 928-640-0337
Fax Number :
Provider Business Practice Location Address
First Line : 3480 E ROUTE 66
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-4032
Country : US
Telephone Number : 928-863-7333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2011
Last Update Date : 01/13/2011

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Directions to “ SAMUEL E CORDIVIN R.T.” Practice Location

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