Basic Information
| Provider Information | |||||||||
| NPI: | 1689766081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDENO | ||||||||
| FirstName: | ISIDRO | ||||||||
| MiddleName: | ACOSTA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7931 INDIAN SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | ORANGEVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956622154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167255494 | ||||||||
| FaxNumber: | 9163513001 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PRISON RD | ||||||||
| Address2: | |||||||||
| City: | REPRESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956713001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169852561 | ||||||||
| FaxNumber: | 9163513001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | A34909 | CA | Y | Other Service Providers | Military Health Care Provider |
No ID Information.