Provider Demographics
NPI:1851052757
Name:CARDENAS, ALEXIS TATIANA (CMT)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:TATIANA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:45 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 SIR FRANCIS DRAKE BLVD STE D
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2552
Practice Address - Country:US
Practice Address - Phone:415-364-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist