Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1740479179 |
---|---|
Provider Name | Robin Cordova |
First Address | Santa Rosa, CA 95403-9067 |
Second Address | Santa Rosa, CA 95403-9067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/09/2009 |