Individual
CORA RIDENOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8631 W 3RD ST # 815E, LOS ANGELES, CA 90048-5901
(310) 858-2224
Mailing address
3325 N 148TH CT APT 3101, OMAHA, NE 68116-7214
(402) 594-8695
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA63295
CA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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