Healthcare Provider Details

I. General information

NPI: 1306610506
Provider Name (Legal Business Name): DESIREE CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 405
LOS ANGELES CA
90067-2007
US

IV. Provider business mailing address

1221 W MARIANA ST
WEST COVINA CA
91790-3541
US

V. Phone/Fax

Practice location:
  • Phone: 310-553-2695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: