Healthcare Provider Details

I. General information

NPI: 1932022852
Provider Name (Legal Business Name): CARMEN SOLEDAD CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 FREDERICK ST STE 200
SANTA CRUZ CA
95062-2239
US

IV. Provider business mailing address

137 MONTEBELLO DR
WATSONVILLE CA
95076-6006
US

V. Phone/Fax

Practice location:
  • Phone: 844-334-7021
  • Fax:
Mailing address:
  • Phone: 209-617-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: