Provider Demographics
NPI:1689417750
Name:CORDOVA, VICTOR RAY
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:RAY
Last Name:CORDOVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5980 WEBB ST
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7625
Mailing Address - Country:US
Mailing Address - Phone:916-652-0171
Mailing Address - Fax:
Practice Address - Street 1:5980 WEBB ST
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-7625
Practice Address - Country:US
Practice Address - Phone:916-652-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator