MEDICARE: AZUCENA A CARDOZO-FONSECA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	14571	CA

General Provider Information

NPI Number	:	1851986723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZUCENA A CARDOZO-FONSECA

Provider Business Mailing Address
First Line	:	3636 N 1ST ST STE 135&154
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6800
Country	:	US
Telephone Number	:	559-225-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST STE 135&154
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6800
Country	:	US
Telephone Number	:	559-225-1464
Fax Number	:

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

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	01/30/2026

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