Provider Demographics
NPI:1962743187
Name:CORDOVA, MIRIAM NOEMI (RN)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:NOEMI
Last Name:CORDOVA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 ELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1209
Mailing Address - Country:US
Mailing Address - Phone:562-923-9414
Mailing Address - Fax:562-923-9451
Practice Address - Street 1:1715 ELWOOD ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1209
Practice Address - Country:US
Practice Address - Phone:562-923-9414
Practice Address - Fax:562-923-9451
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803588163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management