Provider Demographics
NPI:1891254710
Name:CORDERO, JESSICA DAMARIS
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DAMARIS
Last Name:CORDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:DAMARIS
Other - Last Name:CORDERO COTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:10136 ELLENWOOD AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3077
Mailing Address - Country:US
Mailing Address - Phone:916-206-9500
Mailing Address - Fax:
Practice Address - Street 1:6248 66TH AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2733
Practice Address - Country:US
Practice Address - Phone:916-392-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist