Basic Information
| Provider Information | |||||||||
| NPI: | 1982913489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORDERO | ||||||||
| FirstName: | KARI | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 CHADBOURNE RD STE E | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074259670 | ||||||||
| FaxNumber: | 7074259880 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 CHADBOURNE RD STE E | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945349620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074259670 | ||||||||
| FaxNumber: | 7074259880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2010 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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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 | 163WP0808X | 632809 | CA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 95001624 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.