Individual provider Active NPI

Miriam Cardenas, FNP

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1457027005
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95017976 Issued in CA
Practice address
4060 Fairmount Ave
San Diego, CA 92105-1608
Phone
(619) 434-7308
NPI assigned
Aug 23, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95017976 CA Primary

Addresses

Primary practice location

4060 Fairmount Ave
San Diego, CA 92105-1608

Mailing address

4060 Fairmount Ave
San Diego, CA 92105-1608
Phone (619) 434-7308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220210002175 CA Practitioner - Nurse Practitioner 9032507868 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95017976CAMDFamily Nurse Practitioner

Practice roles (4 of 5)

OrganizationSpecialtyStatusNew patients
La Maestra Family Clinic, Inc. CurrentSince Dec 1, 2021 Accepting new patients
La Maestra Family Clinic, Inc. Current Accepting new patients
La Maestra Family Clinic, Inc. CurrentSince Dec 1, 2021 Accepting new patients
La Maestra Family Clinic Past Accepting new patients

Locations

165 S 1st St
El Cajon, CA 92019
Phone (619) 312-0347

4060 Fairmount Ave
San Diego, CA 92105
Phone (619) 255-9155

4171 Fairmount Ave
San Diego, CA 92105
Phone (619) 280-4213

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: miriam.cardenas.p1@direct.lamaestra.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1457027005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-434-7308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FAIRMOUNT AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051608",
            "telephone_number": "619-434-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARDENAS",
        "first_name": "MIRIAM",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.