Healthcare Provider Details

I. General information

NPI: 1487626867
Provider Name (Legal Business Name): PATRICIA CAVENDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23803 MCBEAN PKWY
VALENCIA CA
91355
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-481-2400
  • Fax:
Mailing address:
  • Phone: 818-837-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG52289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: