Provider Demographics
NPI:1013258276
Name:CARDENAS, HAGAR JANNANE
Entity Type:Individual
Prefix:
First Name:HAGAR
Middle Name:JANNANE
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 1:784 THE BURL
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3827
Mailing Address - Country:US
Mailing Address - Phone:209-327-8507
Mailing Address - Fax:
Practice Address - Street 1:1800 TULLY RD
Practice Address - Street 2:SUITE A2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2946
Practice Address - Country:US
Practice Address - Phone:209-622-2142
Practice Address - Fax:209-544-2305
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator