1144384116 NPI number — DORIS CARDENAS MD.

Table of content: DORIS CARDENAS MD. (NPI 1144384116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144384116 NPI number — DORIS CARDENAS MD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDENAS
Provider First Name:
DORIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHACON
Provider Other First Name:
DORIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144384116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91346-9602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-837-5691
Provider Business Mailing Address Fax Number:
818-792-4793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11333 SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-837-5777
Provider Business Practice Location Address Fax Number:
818-869-7143
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  A80492 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A804920 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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