Provider Demographics
NPI:1962070953
Name:CARDOZA, CARLOS CUAUHTEMOC
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:CUAUHTEMOC
Last Name:CARDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4915
Mailing Address - Country:US
Mailing Address - Phone:669-210-9215
Mailing Address - Fax:
Practice Address - Street 1:1421 SQUIRE CT
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-4915
Practice Address - Country:US
Practice Address - Phone:669-210-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent