Provider Demographics
NPI:1639545270
Name:CARDINAL-NIX, WENDY (CMT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CARDINAL-NIX
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21851 NEWLAND ST SPC 292
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7634
Mailing Address - Country:US
Mailing Address - Phone:714-875-0457
Mailing Address - Fax:
Practice Address - Street 1:21851 NEWLAND ST SPC 292
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7634
Practice Address - Country:US
Practice Address - Phone:714-875-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164202083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine