Provider Demographics
NPI:1588363279
Name:CHRIM-CORDERO, ISAIAH S
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:S
Last Name:CHRIM-CORDERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 OXFORD AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1624
Mailing Address - Country:US
Mailing Address - Phone:209-362-6815
Mailing Address - Fax:
Practice Address - Street 1:2020 OXFORD AVE APT 9
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1624
Practice Address - Country:US
Practice Address - Phone:209-362-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty