Provider Demographics
NPI:1598160707
Name:CADE
Entity Type:Organization
Organization Name:CADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:JANNETH
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-234-4377
Mailing Address - Street 1:120- A ROCKWOOD AVENUE
Mailing Address - Street 2:PMB 43373
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:760-701-2440
Mailing Address - Fax:
Practice Address - Street 1:120A ROCKWOOD AVE
Practice Address - Street 2:PMB 43373
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-4700
Practice Address - Country:US
Practice Address - Phone:760-701-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3213567302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization