MEDICARE: PATRICIA P CARDENAS-WALLENFELT MD

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
1	2084P0800X	Psychiatry Physician	963258841205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801980891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA P CARDENAS-WALLENFELT MD

Provider Business Mailing Address
First Line	:	2290 E. 4500 SO.
Second Line	:	SUITE 215
City	:	HOLLADAY
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-274-3625
Fax Number	:

Provider Business Practice Location Address
First Line	:	2290 E. 4500 SO.
Second Line	:	SUITE 215
City	:	HOLLADAY
State	:	UT
Zip	:	84117
Country	:	US
Telephone Number	:	801-274-3625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/26/2013

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