Provider Demographics
NPI:1447060470
Name:CORDOVA, CHRISTINA FAYE ROSE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:FAYE ROSE
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MONTEBELLO DR W
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3613
Mailing Address - Country:US
Mailing Address - Phone:719-373-3719
Mailing Address - Fax:
Practice Address - Street 1:2315 MONTEBELLO DR W
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3613
Practice Address - Country:US
Practice Address - Phone:719-373-3719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist