Healthcare Provider Details

I. General information

NPI: 1700729811
Provider Name (Legal Business Name): EMILIO RAFAEL CARDENAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17240 HEARTBEAT CIR
COVINGTON LA
70435-5757
US

IV. Provider business mailing address

318 COMMERCE ST APT 4
WEST MONROE LA
71291-3109
US

V. Phone/Fax

Practice location:
  • Phone: 985-867-3073
  • Fax:
Mailing address:
  • Phone: 786-473-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: