1356355028 NPI number — MS. CAROL A CARDENAS PT

Table of content: MS. CAROL A CARDENAS PT (NPI 1356355028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356355028 NPI number — MS. CAROL A CARDENAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDENAS
Provider First Name:
CAROL
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
CAROL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356355028
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13116 E MILLERTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORPARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93021-2141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-924-4233
Provider Business Mailing Address Fax Number:
805-733-1213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 REGENCY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27518-8533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-467-7779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006

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: 225100000X , with the licence number:  PT16081 , 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: PT16081 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".