Healthcare Provider Details

I. General information

NPI: 1114033842
Provider Name (Legal Business Name): ANA CARDENAS DERMATOLOGY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CALLOWAY DR SUITE 200
BAKERSFIELD CA
93312-2513
US

IV. Provider business mailing address

3400 CALLOWAY DR SUITE 200
BAKERSFIELD CA
93312-2513
US

V. Phone/Fax

Practice location:
  • Phone: 661-410-7546
  • Fax: 661-410-7547
Mailing address:
  • Phone: 661-410-7546
  • Fax: 661-410-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG86302
License Number StateCA

VIII. Authorized Official

Name: DR. ANA AMPARO CARDENAS
Title or Position: OWNER
Credential: M.D.
Phone: 661-410-7546