Provider Demographics
NPI:1215447768
Name:CORDERO, JOSE (CADC-II)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CORDERO
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14153 WHISPERING SANDS DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5000
Mailing Address - Country:US
Mailing Address - Phone:323-245-2221
Mailing Address - Fax:
Practice Address - Street 1:4445 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2702
Practice Address - Country:US
Practice Address - Phone:323-222-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA168837I101YA0400X
CAAII056390518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)