Provider Demographics
NPI:1144463415
Name:CARDENAS, SAMARA PALACIO (MD)
Entity type:Individual
Prefix:MRS
First Name:SAMARA
Middle Name:PALACIO
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 W LA PALMA AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2805
Mailing Address - Country:US
Mailing Address - Phone:714-535-6419
Mailing Address - Fax:714-535-7222
Practice Address - Street 1:1120 W LA PALMA AVE STE 15
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2805
Practice Address - Country:US
Practice Address - Phone:714-535-6419
Practice Address - Fax:714-535-7222
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA307682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307680Medicaid