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General NPI Number Information
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NPI Number | 1548993389
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Entity Type | Individual
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Provider Name | ANGELICA CARDENAS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 4466 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-5660
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Country | US
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Telephone | 773-728-0966
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Fax | 773-506-3843
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Provider Business Mailing Address
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Address Line | 4300 N MARINE DR APT 1606
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City | CHICAGO
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State | IL
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Zip | 60613-5808
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Country | US
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Telephone | 619-857-3221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.011636
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License Number State | IL
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