| Organization Name: | CORDOVA MEDICAL & DIAGNOSTIC GROUP INC |
| NPI Number: | 1285916221 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARNER GLASSFORD (CFO) |
| Mailing Address: | 26732 Crown Valley Pkwy Ste 421 Mission Viejo |
| State: | CA US |
| Postal Code: | 926916306 |
| Phone Number: | 9493478721 |
| Fax Number: | 9493478709 |
| NPI Enumeration Date: | 09/15/2011 |
| NPI Last Update Date: | 10/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A51101 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |