Healthcare Provider Details

I. General information

NPI: 1336960400
Provider Name (Legal Business Name): ALEXIS CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 AZUSA COURT
RANCHO CUCAMONGA CA
92407
US

IV. Provider business mailing address

7494 LARSEN BAY ST
EASTVALE CA
92880-9197
US

V. Phone/Fax

Practice location:
  • Phone: 877-323-4283
  • Fax:
Mailing address:
  • Phone: 909-973-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: