MEDICARE: DR. ISIDRO ACOSTA CARDENO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider	A34909	CA

General Provider Information

NPI Number	:	1689766081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISIDRO ACOSTA CARDENO M.D.

Provider Business Mailing Address
First Line	:	7931 INDIAN SPRINGS WAY
Second Line	:
City	:	ORANGEVALE
State	:	CA
Zip	:	95662-2154
Country	:	US
Telephone Number	:	916-725-5494
Fax Number	:	916-351-3001

Provider Business Practice Location Address
First Line	:	300 PRISON RD
Second Line	:
City	:	REPRESA
State	:	CA
Zip	:	95671-3001
Country	:	US
Telephone Number	:	916-985-2561
Fax Number	:	916-351-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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