Provider Demographics
NPI:1629655972
Name:CARDENAS, FANNI BARBARA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:FANNI
Middle Name:BARBARA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:FANNI
Other - Middle Name:BARBARA
Other - Last Name:MANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK STREET, MC 0108
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK STREET, MC 0108
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:303-602-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0072881207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000230347Medicaid
CO029570OtherKAISER COMMERCIAL NUMBER