Healthcare Provider Details

I. General information

NPI: 1306772728
Provider Name (Legal Business Name): MARCELA FANDINO CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 DELAWARE ST SE MMC 396
MINNEAPOLIS MN
55455
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 396
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-9996
  • Fax: 612-625-2101
Mailing address:
  • Phone: 612-625-9996
  • Fax: 612-625-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberNA
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: