Doctor Name: | DR. ISIDRO ACOSTA CARDENO |
NPI Number: | 1689766081 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A34909 |
Business Practice Address: | 300 Prison Rd Represa, CA - 956713001 |
Business Phone Number: | 9169852561 |
Business Fax Number: | 9163513001 |
Mailing Address: | 7931 Indian Springs Way, ORANGEVALE |
State: | CA |
Postal Code: | 956622154 |
Phone Number: | 9167255494 |
Fax Number: | 9163513001 |
NPI Enumeration Date: | 09/29/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | A34909 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |