Provider Demographics
NPI:1053061929
Name:CARDENAS, ASHLEY LYNETTE (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNETTE
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8642 GOLDEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-5337
Mailing Address - Country:US
Mailing Address - Phone:619-414-8429
Mailing Address - Fax:
Practice Address - Street 1:9444 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1337
Practice Address - Country:US
Practice Address - Phone:619-414-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190559207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology