Healthcare Provider Details

I. General information

NPI: 1780593541
Provider Name (Legal Business Name): SOFIA CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E DYER RD STE 150
SANTA ANA CA
92705-5662
US

IV. Provider business mailing address

304 E BENWOOD ST
COVINA CA
91722-2816
US

V. Phone/Fax

Practice location:
  • Phone: 949-333-6400
  • Fax:
Mailing address:
  • Phone: 626-533-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT308447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: