Provider Demographics
NPI:1972534600
Name:CARDONA, LUCY F (PHD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:F
Last Name:CARDONA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 476
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-0476
Mailing Address - Country:US
Mailing Address - Phone:909-862-4788
Mailing Address - Fax:
Practice Address - Street 1:2550 E. HIGHLAND AVE.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346
Practice Address - Country:US
Practice Address - Phone:909-862-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS100631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19243ZOtherBLUE CROSS/ BLUE SHIELD
CAZZZ19243ZOtherBLUE CROSS/ BLUE SHIELD