Healthcare Provider Details

I. General information

NPI: 1679358246
Provider Name (Legal Business Name): YOLIBETH ALBERTO CARDENAS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MONO WAY STE I
SONORA CA
95370-2824
US

IV. Provider business mailing address

PO BOX 939
ANGELS CAMP CA
95222-0939
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-9603
  • Fax: 209-533-9604
Mailing address:
  • Phone: 209-288-6681
  • Fax: 209-398-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number35911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: