Healthcare Provider Details

I. General information

NPI: 1639486715
Provider Name (Legal Business Name): JAIRO SANTIAGO CARDENAS M.ED. PPS-SCHL PSYC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CATHEDRAL OAKS RD
SANTA BARBARA CA
93110-1042
US

IV. Provider business mailing address

PO BOX 22433
SANTA BARBARA CA
93121-2433
US

V. Phone/Fax

Practice location:
  • Phone: 805-964-4711
  • Fax:
Mailing address:
  • Phone: 562-533-1462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: