Provider Demographics
NPI:1841752912
Name:CARDENAS, MELANIE ANNETTE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANNETTE
Last Name:CARDENAS
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 1:36809 POMEROL LOOP
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9099
Mailing Address - Country:US
Mailing Address - Phone:760-550-3518
Mailing Address - Fax:
Practice Address - Street 1:36809 POMEROL LOOP
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9099
Practice Address - Country:US
Practice Address - Phone:760-550-3518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician