Basic Information
| Provider Information | |||||||||
| NPI: | 1063613354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORDIER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939053302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317570434 | ||||||||
| FaxNumber: | 8317577038 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S OAK AVE | ||||||||
| Address2: | SUITE A1 | ||||||||
| City: | OAKDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953613572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098488133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A104461 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.