Provider Demographics
NPI:1144361437
Name:CARDONA, CONSUELO (IMF)
Entity type:Individual
Prefix:MS
First Name:CONSUELO
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 W E ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3002
Mailing Address - Country:US
Mailing Address - Phone:323-547-9716
Mailing Address - Fax:
Practice Address - Street 1:790 E BONITA
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:626-254-5000
Practice Address - Fax:626-254-5051
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT110639101YM0800X, 106H00000X
CAAMFT150312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health