Provider Demographics
NPI:1801210364
Name:CARDENAS-JACINTO, CLAUDIA (SA-C, LSA)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:
Last Name:CARDENAS-JACINTO
Suffix:
Gender:F
Credentials:SA-C, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 S HIGLEY RD
Mailing Address - Street 2:SUITE #103-228
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-1166
Mailing Address - Country:US
Mailing Address - Phone:520-252-7474
Mailing Address - Fax:
Practice Address - Street 1:67 S HIGLEY RD
Practice Address - Street 2:SUITE #103-228
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-1166
Practice Address - Country:US
Practice Address - Phone:520-252-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
13-577246ZC0007X
DCSA0124246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant