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NPI Code Detail

MEDICARE: JESUS CARDENAS

MEDICARE: JESUS CARDENAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker97694CA
21041C0700XClinical Social WorkerASW97694CA
3390200000XStudent in an Organized Health Care Education/Training Program

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11518176379OTHERCACASA E- STONEHENGE
2941735271OTHERCATELECARE CORPORATION

General Provider Information

NPI Number : 1053893180
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESUS CARDENAS
Provider Business Mailing Address
First Line : 500 AIRPORT WAY
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-8500
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 AIRPORT WAY
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-8500
Country : US
Telephone Number : 805-437-8013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 12/02/2025

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Directions to “ JESUS CARDENAS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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