Healthcare Provider Details

I. General information

NPI: 1801210364
Provider Name (Legal Business Name): CLAUDIA CARDENAS-JACINTO SA-C, LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S HIGLEY RD SUITE #103-228
GILBERT AZ
85296-1166
US

IV. Provider business mailing address

67 S HIGLEY RD SUITE #103-228
GILBERT AZ
85296-1166
US

V. Phone/Fax

Practice location:
  • Phone: 520-252-7474
  • Fax:
Mailing address:
  • Phone: 520-252-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number13-577
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA0124
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: