Healthcare Provider Details

I. General information

NPI: 1760938906
Provider Name (Legal Business Name): DE CARDENAS SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 SW 2ND AVE APT 1010
MIAMI FL
33130-3581
US

IV. Provider business mailing address

955 SW 2ND AVE APT 1010
MIAMI FL
33130-3581
US

V. Phone/Fax

Practice location:
  • Phone: 305-921-3415
  • Fax:
Mailing address:
  • Phone: 305-921-3415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MADELEINE BARBARA GARCIGA
Title or Position: SECRETARY
Credential:
Phone: 305-989-2682