Healthcare Provider Details

I. General information

NPI: 1043909773
Provider Name (Legal Business Name): ENGLISE CARDONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 ADAMS AVE
SAN DIEGO CA
92116-2592
US

IV. Provider business mailing address

1451 NORMANDY DR
CHULA VISTA CA
91913-3905
US

V. Phone/Fax

Practice location:
  • Phone: 619-326-0157
  • Fax:
Mailing address:
  • Phone: 928-257-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: