Healthcare Provider Details

I. General information

NPI: 1538542709
Provider Name (Legal Business Name): NATALIA MONICA CARDENAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 UNIVERSITY AVE
RIVERSIDE CA
92507-5202
US

IV. Provider business mailing address

665 N D ST
SAN BERNARDINO CA
92401-1109
US

V. Phone/Fax

Practice location:
  • Phone: 951-213-3450
  • Fax: 951-213-3449
Mailing address:
  • Phone: 760-693-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: