Provider Demographics
NPI:1730809187
Name:SIORDIA, CORINA (SA-C)
Entity type:Individual
Prefix:MRS
First Name:CORINA
Middle Name:
Last Name:SIORDIA
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 VISTA DE COLINAS DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2949
Mailing Address - Country:US
Mailing Address - Phone:505-304-5165
Mailing Address - Fax:
Practice Address - Street 1:2319 VISTA DE COLINAS DR SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2949
Practice Address - Country:US
Practice Address - Phone:505-304-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty