MEDICARE: DR. DIEGO G. CARDENAS M.D.

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	207Q00000X	Family Medicine Physician	19750	AZ

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	:	1831153691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEGO G. CARDENAS M.D.

Provider Business Mailing Address
First Line	:	5130 W BASELINE RD
Second Line	:	STE 103
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2984
Country	:	US
Telephone Number	:	602-237-0039
Fax Number	:	602-237-7824

Provider Business Practice Location Address
First Line	:	8620 N 22ND AVE
Second Line	:	200
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4251
Country	:	US
Telephone Number	:	602-674-6501
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	10/31/2011

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