Healthcare Provider Details

I. General information

NPI: 1285943654
Provider Name (Legal Business Name): KATRINA ARMIDA CARDENAS GAINES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA ARMIDA CARDENAS

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S VAL VISTA DR
GILBERT AZ
85297-7323
US

IV. Provider business mailing address

2108 E THOMAS RD STE 130
PHOENIX AZ
85016-0008
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0777
  • Fax: 602-933-0755
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4738
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4738
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: