Provider Demographics
NPI:1750390084
Name:CARDENAS, CARRIE LYNN (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3330 3RD AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-819-7227
Mailing Address - Fax:619-299-7430
Practice Address - Street 1:3330 3RD AVE STE 402
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-819-7227
Practice Address - Fax:619-299-7430
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A727440Medicaid
CA00A727440Medicaid
CAWA72744AMedicare ID - Type Unspecified