Provider Demographics
NPI:1669129847
Name:CARDENAS, CARISSA (CPT)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:M
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT
Mailing Address - Street 1:3410 WINDMILL CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7592
Mailing Address - Country:US
Mailing Address - Phone:951-206-4475
Mailing Address - Fax:
Practice Address - Street 1:3410 WINDMILL CT
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7592
Practice Address - Country:US
Practice Address - Phone:951-206-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW9M3X3M7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy