Provider Demographics
NPI:1659127140
Name:CARDENAS, JESUS ROGER
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ROGER
Last Name:CARDENAS
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 1:225 S LAKE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3009
Mailing Address - Country:US
Mailing Address - Phone:626-410-0299
Mailing Address - Fax:
Practice Address - Street 1:225 S LAKE AVE STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3009
Practice Address - Country:US
Practice Address - Phone:626-410-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician