Provider Demographics
NPI:1275651085
Name:CORDOVA CAMPOS, RITA (MSW ACSW)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:
Last Name:CORDOVA CAMPOS
Suffix:
Gender:F
Credentials:MSW ACSW
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 607071
Mailing Address - Street 2:PMB 36
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7071
Mailing Address - Country:US
Mailing Address - Phone:787-593-0647
Mailing Address - Fax:787-740-2559
Practice Address - Street 1:ROAD #2 BAYAMON SHOPPING CENTER
Practice Address - Street 2:SUITE 10 E MINI MALL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-9097
Practice Address - Fax:787-740-2559
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR117024OtherFHCHS OR PR
PR635OtherAPS HEALTHCARE