Provider Demographics
NPI:1033964267
Name:CARDOZO JIMENEZ, CARLO SALVADOR
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:SALVADOR
Last Name:CARDOZO JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CARLO
Other - Middle Name:SALVADOR
Other - Last Name:CARDOZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:295 S CHIPETA WAY STE 22
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1234
Mailing Address - Country:US
Mailing Address - Phone:801-581-7766
Mailing Address - Fax:
Practice Address - Street 1:295 S CHIPETA WAY STE 22
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1234
Practice Address - Country:US
Practice Address - Phone:801-581-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program