Healthcare Provider Details

I. General information

NPI: 1053688259
Provider Name (Legal Business Name): PATRICIA L CARDENAS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643 N 3RD ST
FRESNO CA
93726-1637
US

IV. Provider business mailing address

4643 N 3RD ST
FRESNO CA
93726-1637
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-1433
  • Fax:
Mailing address:
  • Phone: 559-486-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number115486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: