Healthcare Provider Details

I. General information

NPI: 1912466178
Provider Name (Legal Business Name): ROXANA JEANETTE CARDENAS M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 E SHAW AVE STE 110
FRESNO CA
93710-7905
US

IV. Provider business mailing address

7226 SEPULVEDA BLVD
VAN NUYS CA
91405-2003
US

V. Phone/Fax

Practice location:
  • Phone: 559-754-1517
  • Fax:
Mailing address:
  • Phone: 818-235-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-17-8262
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: