Basic Information
| Provider Information | |||||||||
| NPI: | 1467861252 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDOZA | ||||||||
| FirstName: | MARLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8069 MARINERS DR | ||||||||
| Address2: | APT 2202 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952195419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095076965 | ||||||||
| FaxNumber: | 2094781938 | ||||||||
| Practice Location | |||||||||
| Address1: | 8069 MARINERS DR | ||||||||
| Address2: | APT 2202 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952195419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095076965 | ||||||||
| FaxNumber: | 2094781938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106H00000X | 87554 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.