Healthcare Provider Details

I. General information

NPI: 1427219336
Provider Name (Legal Business Name): SERGIO CARDENAS MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10370 SW 200TH TER
CUTLER BAY FL
33189-1333
US

IV. Provider business mailing address

10370 SW 200TH TER
CUTLER BAY FL
33189-1333
US

V. Phone/Fax

Practice location:
  • Phone: 305-969-2718
  • Fax: 305-969-2718
Mailing address:
  • Phone: 305-969-2718
  • Fax: 305-969-2718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA39839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: