Provider Demographics
NPI:1124191275
Name:CARDENAS, RODOLFO FELIX (OMD LAC)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:FELIX
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:OMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9035 WOODALE AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-5826
Mailing Address - Country:US
Mailing Address - Phone:818-504-9782
Mailing Address - Fax:
Practice Address - Street 1:14600 SHERMAN WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2283
Practice Address - Country:US
Practice Address - Phone:818-756-2519
Practice Address - Fax:818-904-0479
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist