Healthcare Provider Details

I. General information

NPI: 1629566013
Provider Name (Legal Business Name): DANIEL PENSER CARDENAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL ST FL 6
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

234 E 149TH ST
BRONX NY
10451-5504
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9700
  • Fax:
Mailing address:
  • Phone: 718-579-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberD0106979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: