Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19101 | CA |
NPI | 1003133984 |
---|---|
Provider Name | Blanca Estela Cardenas |
First Address | San Diego, CA 92113-1738 |
Second Address | Chula Vista, CA 91910-3813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 15/06/2011 |