Provider Demographics
NPI:1689429292
Name:CARDENAS, JOSE M I
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:CARDENAS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1512
Mailing Address - Country:US
Mailing Address - Phone:415-342-7838
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD STE B1
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:888-818-1115
Practice Address - Fax:415-532-2144
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker