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General NPI Number Information
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NPI Number | 1710700356
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Entity Type | Individual
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Provider Name | RENEE CARDENAS
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3109 COFFEE RD STE A
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City | MODESTO
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State | CA
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Zip | 95355-1766
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Country | US
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Telephone | 209-522-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 15190 N LOCUST TREE RD
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City | LODI
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State | CA
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Zip | 95240-9349
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Country | US
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Telephone | 209-747-7182
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95032832
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License Number State | CA
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