Healthcare Provider Details

I. General information

NPI: 1598705519
Provider Name (Legal Business Name): VICTOR J CARDENAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 ANN ARBOR CT
SUGAR LAND TX
77478-3709
US

IV. Provider business mailing address

3111 ANN ARBOR CT
SUGAR LAND TX
77478-3709
US

V. Phone/Fax

Practice location:
  • Phone: 713-819-1077
  • Fax: 281-491-0379
Mailing address:
  • Phone: 713-819-1077
  • Fax: 281-491-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE0418
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberE0418
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberE0418
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberE0418
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: