Individual
AVERY CORRINE CORDOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
354 S HALCYON RD STE C, ARROYO GRANDE, CA 93420-3879
(805) 473-7060
Mailing address
354 S HALCYON RD STE C, ARROYO GRANDE, CA 93420-3879
(805) 473-7060
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37349
CA
Other
Enumeration date
12/27/2022
Last updated
12/27/2022
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