Provider Demographics
NPI:1770967549
Name:CARDENAS CASTILLO, YLEC MARIANA (MD)
Entity type:Individual
Prefix:
First Name:YLEC
Middle Name:MARIANA
Last Name:CARDENAS CASTILLO
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 1:800 HOWARD AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1369
Mailing Address - Country:US
Mailing Address - Phone:203-737-6050
Mailing Address - Fax:203-785-4960
Practice Address - Street 1:800 HOWARD AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-737-6050
Practice Address - Fax:203-785-4960
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT208366390200000X
CT640822084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program