Basic Information
| Provider Information | |||||||||
| NPI: | 1760615249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORDOVA | ||||||||
| FirstName: | NATALIA | ||||||||
| MiddleName: | ISABEL | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6428 CAPE CHARLES DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276177641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192474551 | ||||||||
| FaxNumber: | 9199323456 | ||||||||
| Practice Location | |||||||||
| Address1: | 7250 BURLINGTON RD | ||||||||
| Address2: | |||||||||
| City: | HURDLE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275419325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365142423 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2009 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 8579 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.