Healthcare Provider Details

I. General information

NPI: 1770866907
Provider Name (Legal Business Name): ALMA VICTORIA CARDENAS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HERMANOS ESCOBAR 3212
JUAREZ CHIHUAHUA
32390
MX

IV. Provider business mailing address

6212 PAPAGO RD
EL PASO TX
79905-2137
US

V. Phone/Fax

Practice location:
  • Phone: 011526112006
  • Fax:
Mailing address:
  • Phone: 915-235-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1492009
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: