Cordova, Samuel Mauricio

Cordova, Samuel Mauricio is an individual health care provider with primary practice located at 1259 Rickert Dr Ste 101 , Naperville IL 60540-8904. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Cordova, Samuel Mauricio can be contacted via phone (630) 355-1300.

Contact Information

Primary practice address
1259 Rickert Dr Ste 101 Naperville IL 60540-8904
Phone: (630) 355-1300
Fax: (630) 355-3273
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 85002213 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085002213 Illinois

Profile Details

NPI number 1326137225
LBN Legal business name Cordova, Samuel Mauricio
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Dec 13th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326137225 NPPES
Illinois MEDICAID 085002213
Illinois Other 970023229

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