Provider Demographics
NPI:1326171570
Name:CARDENAS, ANDRE MAURICE (IDC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:MAURICE
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W MARINE VIEW DR
Mailing Address - Street 2:BLDG 2010
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98207-0001
Mailing Address - Country:US
Mailing Address - Phone:425-304-4157
Mailing Address - Fax:425-304-4126
Practice Address - Street 1:2000 W MARINE VIEW DR
Practice Address - Street 2:BLDG 2010
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-0001
Practice Address - Country:US
Practice Address - Phone:425-304-4157
Practice Address - Fax:425-304-4126
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman