Provider Demographics
NPI:1831153691
Name:CARDENAS, DIEGO G (MD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:G
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 W BASELINE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2984
Mailing Address - Country:US
Mailing Address - Phone:602-237-0039
Mailing Address - Fax:602-237-7824
Practice Address - Street 1:8620 N 22ND AVE
Practice Address - Street 2:200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4251
Practice Address - Country:US
Practice Address - Phone:602-674-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ469008Medicaid
AZF08786Medicare UPIN
AZZ106688Medicare PIN
AZ469008Medicaid