Provider Demographics
NPI:1043838428
Name:CARDONA VELASCO, KENIA (RDN)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:CARDONA VELASCO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1365
Mailing Address - Country:US
Mailing Address - Phone:661-862-5422
Mailing Address - Fax:661-322-5489
Practice Address - Street 1:815 DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1365
Practice Address - Country:US
Practice Address - Phone:661-862-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
86069328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043838428OtherNOT YET ACCEPTING INSURANCE.