Individual
SAMUEL E CORDIVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.T.
Contact information
Practice address
3480 E ROUTE 66, FLAGSTAFF, AZ 86004-4032
(928) 863-7333
Mailing address
3860 E SIOUX DR, 11A, FLAGSTAFF, AZ 86001-6668
(928) 640-0337
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
15727
AZ
Other
Enumeration date
01/13/2011
Last updated
01/13/2011
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