Provider Demographics
NPI:1649078031
Name:CARDENAS, ALEXIS EDUARDO (PTA)
Entity type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:EDUARDO
Last Name:CARDENAS
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 CALLE REAL SPC 56
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-3999
Mailing Address - Country:US
Mailing Address - Phone:805-235-1775
Mailing Address - Fax:
Practice Address - Street 1:5432 CARPINTERIA AVE
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1423
Practice Address - Country:US
Practice Address - Phone:805-566-0600
Practice Address - Fax:805-566-0637
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant