Provider Demographics
NPI:1073174702
Name:CARDENAS, LEA (MOT)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19991 SANTA MARIA AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4244
Mailing Address - Country:US
Mailing Address - Phone:559-960-4719
Mailing Address - Fax:
Practice Address - Street 1:3025 HIGH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1807
Practice Address - Country:US
Practice Address - Phone:510-261-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17321225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist