Provider Demographics
NPI:1962192823
Name:CARDOZA, AIMEE RENE (RADT)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:RENE
Last Name:CARDOZA
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7595
Mailing Address - Country:US
Mailing Address - Phone:888-474-1601
Mailing Address - Fax:
Practice Address - Street 1:330 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3958
Practice Address - Country:US
Practice Address - Phone:209-744-9909
Practice Address - Fax:209-744-9910
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
CAR1506460523172V00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)