Healthcare Provider Details

I. General information

NPI: 1427399450
Provider Name (Legal Business Name): FERNANDO DE CARDENAS L.M.H.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 02/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SW 81ST DR SUITE # 290
MIAMI FL
33143-6603
US

IV. Provider business mailing address

8724 SUNSET DR NO. 152
MIAMI FL
33173-3512
US

V. Phone/Fax

Practice location:
  • Phone: 305-270-7968
  • Fax:
Mailing address:
  • Phone: 305-270-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: