Individual
MAYRA L CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1119088 PA
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1119088
PA CERTIFICATE
TX
Enumeration date
10/03/2014
Last updated
10/03/2014
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