Active NPI
Kenneth J Cordova, MOTRL
- Occupational Therapist
- Albuquerque, NM
National Provider Identifier
1891841540
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2214
- Practice address
- 2916 Dorothy St NE
Albuquerque, NM 87112-1619 - Phone
- (505) 244-4175
- Fax
- (505) 332-3043
- NPI assigned
- Jan 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2214 | NM | Primary |
Addresses
Primary practice location
2916 Dorothy St NE
Albuquerque, NM 87112-1619
Mailing address
PO Box 53363
Albuquerque, NM 87153-3363
Phone (505) 730-9540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46131264 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2214 | NM | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235952000000",
"number": "1891841540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 53363",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871533363",
"telephone_number": "505-730-9540",
"fax_number": "505-332-3043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2916 DOROTHY ST NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871121619",
"telephone_number": "505-244-4175",
"fax_number": "505-332-3043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDOVA",
"first_name": "KENNETH",
"middle_name": "J",
"credential": "MOTRL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-26",
"last_updated": "2009-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "2214",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "46131264",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.