Healthcare Provider Details

I. General information

NPI: 1720600224
Provider Name (Legal Business Name): JORGE DE CARDENAS LBA- BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S VINEYARD STE 223
MESA AZ
85210-6826
US

IV. Provider business mailing address

3249 E INDIGO BAY CT
GILBERT AZ
85234-1736
US

V. Phone/Fax

Practice location:
  • Phone: 480-656-3530
  • Fax: 480-685-9879
Mailing address:
  • Phone: 602-615-8205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-002092
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-1-07-3468
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: