Healthcare Provider Details

I. General information

NPI: 1356037691
Provider Name (Legal Business Name): BRIANNA CARDENAS, PHYSICIAN ASSISTANT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WESTLAKE AVE N STE 100
SEATTLE WA
98109-6212
US

IV. Provider business mailing address

2105 FOOTHILL BLVD STE B154
LA VERNE CA
91750-2901
US

V. Phone/Fax

Practice location:
  • Phone: 206-379-1213
  • Fax: 206-492-2003
Mailing address:
  • Phone: 206-379-1213
  • Fax: 206-492-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIANNA RENEE CARDENAS
Title or Position: CEO
Credential: DMSC, PA-C, ATC
Phone: 909-375-9011