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NPI Code Detail

MEDICARE: JORGE DE CARDENAS RBT

MEDICARE: JORGE DE CARDENAS RBT
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
1106S00000XBehavior TechnicianRBT-1-07-3468FL

General Provider Information

NPI Number : 1720600224
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORGE DE CARDENAS RBT
Provider Business Mailing Address
First Line : 3249 E INDIGO BAY CT
Second Line :
City : GILBERT
State : AZ
Zip : 85234-1736
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2045 S VINEYARD STE 223
Second Line :
City : MESA
State : AZ
Zip : 85210-6826
Country : US
Telephone Number : 480-656-3530
Fax Number : 480-685-9879
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2020
Last Update Date : 05/07/2020

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Directions to “ JORGE DE CARDENAS RBT” Practice Location

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