Provider Demographics
NPI:1780035634
Name:CARDENAS, AIMEE (RPT)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:ANTONIO
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39643 ASHLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6716
Mailing Address - Country:US
Mailing Address - Phone:323-459-5731
Mailing Address - Fax:
Practice Address - Street 1:39643 ASHLAND WAY
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6716
Practice Address - Country:US
Practice Address - Phone:323-459-5731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist