Provider Demographics
NPI:1467035634
Name:CARDENAS OLARTE, LILIAM KATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:LILIAM
Middle Name:KATHERINE
Last Name:CARDENAS OLARTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6802 W VALLEY MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3378
Mailing Address - Country:US
Mailing Address - Phone:714-654-7555
Mailing Address - Fax:
Practice Address - Street 1:3590 W 9000 S STE 240
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8864
Practice Address - Country:US
Practice Address - Phone:801-508-3140
Practice Address - Fax:801-208-6374
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13012366-1206363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant