Provider Demographics
NPI:1063613354
Name:CORDIER, JENNIFER R (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:CORDIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-3302
Mailing Address - Country:US
Mailing Address - Phone:831-757-0434
Mailing Address - Fax:831-757-7038
Practice Address - Street 1:250 S OAK AVE
Practice Address - Street 2:SUITE A1
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3572
Practice Address - Country:US
Practice Address - Phone:209-848-8133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104461208000000X
OH57-010454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics