Healthcare Provider Details

I. General information

NPI: 1487643664
Provider Name (Legal Business Name): CARLOS A CARDENAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MCCULLOUGH AVE STE 533
SAN ANTONIO TX
78212-5609
US

IV. Provider business mailing address

609 GRANDVIEW PL
SAN ANTONIO TX
78209-5417
US

V. Phone/Fax

Practice location:
  • Phone: 210-465-5455
  • Fax: 210-600-4033
Mailing address:
  • Phone: 210-413-8890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberE9560
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: