Provider Demographics
NPI:1871233411
Name:CALLEJAS CARDENAS, DANIELA CALLEJAS CARDENAS
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:CALLEJAS CARDENAS
Last Name:CALLEJAS 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 1:2311 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3243
Mailing Address - Country:US
Mailing Address - Phone:270-933-8101
Mailing Address - Fax:
Practice Address - Street 1:2311 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3243
Practice Address - Country:US
Practice Address - Phone:270-933-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant