Provider Demographics
NPI:1508893710
Name:CARDOZA, JIMMY (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:CARDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2520
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:
Practice Address - Street 1:2125 OAK GROVE RD STE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2520
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG551932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G5519311Medicare PIN
CA00G5519310Medicare PIN
CA00G5519320Medicare PIN
CA00G551937Medicare PIN
CAE72086Medicare UPIN
CA00G5519313Medicare PIN
CA00G5519314Medicare PIN
CA00G5519316Medicare PIN
CA00G5519317Medicare PIN
CA00G5519319Medicare PIN
CA00G551934Medicare PIN
CA00G551936Medicare PIN
CA00G5519318Medicare PIN
CA00G551935Medicare PIN
CA00G5519312Medicare PIN
CA300097028Medicare PIN
CA00G5519315Medicare PIN
CA00G551932Medicare PIN
CA00G551933Medicare PIN
CA00G551938Medicare PIN
CA300034858Medicare PIN
CA300104425Medicare PIN
CA00G551930Medicare PIN
CA00G551939Medicare PIN
CA00G5519321Medicare PIN
CA00G551931Medicare PIN