Provider Demographics
NPI:1114284817
Name:CARDINAL WELLNESS, INC.
Entity Type:Organization
Organization Name:CARDINAL WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGREDANO DE MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-529-7864
Mailing Address - Street 1:15814 WINCHESTER BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-3333
Mailing Address - Country:US
Mailing Address - Phone:408-529-7864
Mailing Address - Fax:408-331-3211
Practice Address - Street 1:15814 WINCHESTER BLVD STE 105
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-3333
Practice Address - Country:US
Practice Address - Phone:408-529-7864
Practice Address - Fax:408-331-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2017-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA964502084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty