Provider Demographics
NPI:1801980891
Name:CARDENAS-WALLENFELT, PATRICIA P (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:CARDENAS-WALLENFELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W WASHINGTON ST # 2328
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1946
Mailing Address - Country:US
Mailing Address - Phone:858-298-6314
Mailing Address - Fax:
Practice Address - Street 1:325 W WASHINGTON ST # 2328
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1946
Practice Address - Country:US
Practice Address - Phone:858-298-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0763922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT788007788046Medicaid