Provider Demographics
NPI:1972881886
Name:CORDERO, CATHERINE MAUREEN (CPNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MAUREEN
Last Name:CORDERO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MAUREEN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:901 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6603
Practice Address - Country:US
Practice Address - Phone:805-614-9275
Practice Address - Fax:805-614-9285
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20939363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70984FMedicaid
CA551974Medicare Oscar/Certification
CAW1508BMedicare PIN