Healthcare Provider Details

I. General information

NPI: 1083250690
Provider Name (Legal Business Name): TONII MARIE CARDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD
VICTORVILLE CA
92395-7720
US

IV. Provider business mailing address

44444 20TH STREET WEST
LANCASTER CA
93535
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax: 760-955-8171
Mailing address:
  • Phone: 661-951-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10508
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: