Provider Demographics
NPI:1598024572
Name:CARDENAS, VERONICA (PHD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9252 GARDEN GROVE BLVD STE 19
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1436
Mailing Address - Country:US
Mailing Address - Phone:619-333-6764
Mailing Address - Fax:
Practice Address - Street 1:12032 FAIRHOPE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2050
Practice Address - Country:US
Practice Address - Phone:619-333-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical