Provider Demographics
NPI:1497210298
Name:CARDENAS, VICTOR JR
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:CARDENAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 WEST DR APT 16
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6136
Mailing Address - Country:US
Mailing Address - Phone:760-496-4082
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ STE 107
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2637
Practice Address - Country:US
Practice Address - Phone:760-304-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician