| Doctor Name: | MARISSA ANNE CORDERO |
| NPI Number: | 1568593101 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. |
| License Number: | IMF47546 |
| Business Practice Address: | 12450 Van Nuys Blvd Suite 100 Pacoima, CA - 913311391 |
| Business Phone Number: | 8188968366 |
| Business Fax Number: | |
| Mailing Address: | 11738 Magnolia Blvd Apt 3, VALLEY VILLAGE |
| State: | CA |
| Postal Code: | 916075604 |
| Phone Number: | 8186453659 |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2007 |
| NPI Last Update Date: | 03/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | IMF47546 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |