Healthcare Provider Details

I. General information

NPI: 1689766081
Provider Name (Legal Business Name): ISIDRO ACOSTA CARDENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PRISON RD
REPRESA CA
95671-3001
US

IV. Provider business mailing address

7931 INDIAN SPRINGS WAY
ORANGEVALE CA
95662-2154
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-2561
  • Fax: 916-351-3001
Mailing address:
  • Phone: 916-725-5494
  • Fax: 916-351-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberA34909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: