Individual
MISS GINA CELINE CORDERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
520 S EAGLE RD STE 3213, MERIDIAN, ID 83642-6356
(208) 706-2663
Mailing address
520 S EAGLE RD STE 3213, MERIDIAN, ID 83642-6356
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-676
ID
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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