Individual
KENNETH J CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOTRL
Contact information
Practice address
2916 DOROTHY ST NE, ALBUQUERQUE, NM 87112-1619
(505) 244-4175
(505) 332-3043
Mailing address
PO BOX 53363, ALBUQUERQUE, NM 87153-3363
(505) 730-9540
(505) 332-3043
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2214
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46131264
—
NM
Enumeration date
01/26/2007
Last updated
03/02/2009
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