Provider Demographics
NPI:1114033842
Name:ANA CARDENAS DERMATOLOGY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANA CARDENAS DERMATOLOGY, A PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED COSMETIC DERMATOLOGY, A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:AMPARO
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-410-7546
Mailing Address - Street 1:3400 CALLOWAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2513
Mailing Address - Country:US
Mailing Address - Phone:661-410-7546
Mailing Address - Fax:661-410-7547
Practice Address - Street 1:3400 CALLOWAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2513
Practice Address - Country:US
Practice Address - Phone:661-410-7546
Practice Address - Fax:661-410-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86302207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02042ZOtherPTAN