Provider Demographics
NPI:1659562809
Name:CARDIFF, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CARDIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:SKYFOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92385-0578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28545 HWY 18
Practice Address - Street 2:
Practice Address - City:SKYFOREST
Practice Address - State:CA
Practice Address - Zip Code:92385-0578
Practice Address - Country:US
Practice Address - Phone:909-336-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5875101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor