Healthcare Provider Details

I. General information

NPI: 1831605138
Provider Name (Legal Business Name): REBECCA CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-2475
US

IV. Provider business mailing address

3550 CAMINO DEL RIO N
SAN DIEGO CA
92108-1737
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-6987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: