Healthcare Provider Details

I. General information

NPI: 1477067957
Provider Name (Legal Business Name): RICK CARDENAS MD & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 MARBLE AVE NE STE 1
ALBUQUERQUE NM
87110-7901
US

IV. Provider business mailing address

PO BOX 43
CEDAR CREST NM
87008-0043
US

V. Phone/Fax

Practice location:
  • Phone: 505-200-0667
  • Fax: 505-255-1813
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICK CARDENAS
Title or Position: OWNER
Credential: MD
Phone: 575-317-4113