Provider Demographics
NPI:1851057731
Name:CORNELIUS, NAKIA MARIE
Entity type:Individual
Prefix:
First Name:NAKIA
Middle Name:MARIE
Last Name:CORNELIUS
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 1:4563 W AVENUE M4 UNIT N
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2948
Mailing Address - Country:US
Mailing Address - Phone:661-470-4906
Mailing Address - Fax:
Practice Address - Street 1:43862 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5043
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator