Provider Demographics
NPI:1023413648
Name:CADE
Entity type:Organization
Organization Name:CADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:JANNETH
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-234-4377
Mailing Address - Street 1:A ROCKWOOD AVE
Mailing Address - Street 2:PMB 43373
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:760-206-9680
Mailing Address - Fax:
Practice Address - Street 1:F #1399-B COL NUEVA
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BC
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:760-206-9680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3213567302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization