Provider Demographics
NPI:1245465525
Name:CARDENAS, MIGUEL ANGEL (NONE)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 E MAIN ST
Mailing Address - Street 2:VENTURA
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3027
Mailing Address - Country:US
Mailing Address - Phone:805-652-0596
Mailing Address - Fax:805-652-0608
Practice Address - Street 1:1065 E MAIN ST
Practice Address - Street 2:VENTURA
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3027
Practice Address - Country:US
Practice Address - Phone:805-652-0596
Practice Address - Fax:805-652-0608
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMACARDENAS1Medicare PIN