Healthcare Provider Details

I. General information

NPI: 1790266377
Provider Name (Legal Business Name): MARIA GUADALUPE CARDENAS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 06/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076
US

IV. Provider business mailing address

3400 STEVENSON BLVD APT P31
FREMONT CA
94538-5848
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone: 831-998-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34020TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: