Healthcare Provider Details

I. General information

NPI: 1649078031
Provider Name (Legal Business Name): ALEXIS EDUARDO CARDENAS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 CARPINTERIA AVE
CARPINTERIA CA
93013-1423
US

IV. Provider business mailing address

4280 CALLE REAL SPC 56
SANTA BARBARA CA
93110-3999
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0600
  • Fax: 805-566-0637
Mailing address:
  • Phone: 805-235-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: