Healthcare Provider Details

I. General information

NPI: 1619443389
Provider Name (Legal Business Name): CLAUDIA CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 N 3RD AVE
PHOENIX AZ
85013-4434
US

IV. Provider business mailing address

240 W THOMAS RD # 301
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8811
  • Fax: 602-406-8810
Mailing address:
  • Phone: 602-406-7765
  • Fax: 602-294-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: