Healthcare Provider Details

I. General information

NPI: 1437466794
Provider Name (Legal Business Name): AMAPOLA CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CARMEN LN STE 201
SANTA MARIA CA
93458-7771
US

IV. Provider business mailing address

201 CARMEN LN
SANTA MARIA CA
93458-7722
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-7680
  • Fax:
Mailing address:
  • Phone: 805-348-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number250604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: