Healthcare Provider Details

I. General information

NPI: 1114821303
Provider Name (Legal Business Name): MARICRUZ CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12350 INTERSTATE 45 N
WILLIS TX
77378-4734
US

IV. Provider business mailing address

12350 INTERSTATE 45 N
WILLIS TX
77378-4734
US

V. Phone/Fax

Practice location:
  • Phone: 936-272-1027
  • Fax:
Mailing address:
  • Phone: 936-272-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30311492
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: