Provider Demographics
NPI:1043510589
Name:CORDOVA, FLORINA A (MS)
Entity type:Individual
Prefix:
First Name:FLORINA
Middle Name:A
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:SAN CRISTOBAL
Mailing Address - State:NM
Mailing Address - Zip Code:87564-0003
Mailing Address - Country:US
Mailing Address - Phone:575-741-0081
Mailing Address - Fax:
Practice Address - Street 1:530 CAMINO DEL MEDIO TRLR 15
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-8217
Practice Address - Country:US
Practice Address - Phone:575-758-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist