Healthcare Provider Details

I. General information

NPI: 1053061929
Provider Name (Legal Business Name): ASHLEY LYNETTE CARDENAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9444 MEDICAL CENTER DR
LA JOLLA CA
92037-1337
US

IV. Provider business mailing address

8642 GOLDEN RIDGE RD
LAKESIDE CA
92040-5337
US

V. Phone/Fax

Practice location:
  • Phone: 619-414-8429
  • Fax:
Mailing address:
  • Phone: 619-414-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number190559
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA190559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: