Individual
MRS. ELLEN DIANE CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4246
(623) 876-8816
(623) 298-0168
Mailing address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4246
(623) 876-8816
(623) 298-0168
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8689
AZ
Other
Enumeration date
09/01/2021
Last updated
09/29/2021
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