Basic Information
| Provider Information | |||||||||
| NPI: | 1003130162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDOVA | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | VICTORIA | ||||||||
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| Credential: | MFT INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 BELLEVUE AVE | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940141307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152611164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 EXECUTIVE PARK BLVD | ||||||||
| Address2: | SUITE 4900 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941343394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 62873 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.