MEDICARE: WENDY M CORDERO

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	R1308310518	CA

General Provider Information

NPI Number	:	1902375181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY M CORDERO

Provider Business Mailing Address
First Line	:	6961 WHITSETT AVE APT 20
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5425
Country	:	US
Telephone Number	:	818-309-3231
Fax Number	:

Provider Business Practice Location Address
First Line	:	6961 WHITSETT AVE APT 20
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-5425
Country	:	US
Telephone Number	:	818-309-3231
Fax Number	:

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

Provider Enumeration Date	:	11/17/2018
Last Update Date	:	11/17/2018

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Directions to “ WENDY M CORDERO ” Practice Location

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