Provider Demographics
NPI:1962193771
Name:CARDENAS, NANCY EMMA
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:EMMA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10089 WILLOW CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1699
Mailing Address - Country:US
Mailing Address - Phone:619-793-2005
Mailing Address - Fax:
Practice Address - Street 1:10089 WILLOW CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1699
Practice Address - Country:US
Practice Address - Phone:619-793-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty