Provider Demographics
NPI:1639352495
Name:CARDOZA, BRIAN (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CARDOZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 CUDAHY PL
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3931
Mailing Address - Country:US
Mailing Address - Phone:619-276-8112
Mailing Address - Fax:619-276-8230
Practice Address - Street 1:1094 CUDAHY PL
Practice Address - Street 2:SUITE 314
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3931
Practice Address - Country:US
Practice Address - Phone:619-276-8112
Practice Address - Fax:619-276-8230
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588882163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health