Provider Demographics
NPI:1538412267
Name:CORDERO, MARIA SAGRARIO (MS, LAC)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:SAGRARIO
Last Name:CORDERO
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520477
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84152-0477
Mailing Address - Country:US
Mailing Address - Phone:801-673-6795
Mailing Address - Fax:801-415-9525
Practice Address - Street 1:2290 E 4500 S
Practice Address - Street 2:SUITE 110
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4492
Practice Address - Country:US
Practice Address - Phone:801-673-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT74809401201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist