Provider Demographics
NPI:1689766081
Name:CARDENO, ISIDRO ACOSTA (MD)
Entity Type:Individual
Prefix:DR
First Name:ISIDRO
Middle Name:ACOSTA
Last Name:CARDENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7931 INDIAN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-2154
Mailing Address - Country:US
Mailing Address - Phone:916-725-5494
Mailing Address - Fax:916-351-3001
Practice Address - Street 1:300 PRISON RD
Practice Address - Street 2:
Practice Address - City:REPRESA
Practice Address - State:CA
Practice Address - Zip Code:95671-3001
Practice Address - Country:US
Practice Address - Phone:916-985-2561
Practice Address - Fax:916-351-3001
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34909171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider