Healthcare Provider Details

I. General information

NPI: 1487373726
Provider Name (Legal Business Name): LORI CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S. SUNWEST LANE, SUITE 200
SAN BERNARDINO CA
92408
US

IV. Provider business mailing address

1950 S. SUNWEST LANE, SUITE 200
SAN BERNARDINO CA
92408
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-4017
  • Fax: 909-252-4055
Mailing address:
  • Phone: 909-252-4017
  • Fax: 909-252-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-29143
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: