Provider Demographics
NPI:1447093695
Name:CORDOVA, ANNACELA ESTRELLA
Entity type:Individual
Prefix:
First Name:ANNACELA
Middle Name:ESTRELLA
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 1:801 S WINCHESTER BLVD APT 4107
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2985
Mailing Address - Country:US
Mailing Address - Phone:505-699-2995
Mailing Address - Fax:
Practice Address - Street 1:1835 PARK AVE # 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1629
Practice Address - Country:US
Practice Address - Phone:408-855-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician