Provider Demographics
NPI:1326116211
Name:CASA CARDENAS
Entity Type:Organization
Organization Name:CASA CARDENAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:626-337-6650
Mailing Address - Street 1:P.O. BOX 41 1141
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041
Mailing Address - Country:US
Mailing Address - Phone:626-337-6650
Mailing Address - Fax:626-960-2870
Practice Address - Street 1:111 W BEVERLY BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4312
Practice Address - Country:US
Practice Address - Phone:626-337-6650
Practice Address - Fax:626-960-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health