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General NPI Number Information
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NPI Number | 1053751966
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Entity Type | Organization
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Legal Business Name | OMAR CARDENAS, MD PA
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 2101 CURRY RD
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City | LUTZ
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State | FL
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Zip | 33549-3716
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Country | US
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Telephone | 813-501-7407
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Fax | 813-964-3113
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Provider Business Mailing Address
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Address Line | 2101 CURRY RD
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City | LUTZ
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State | FL
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Zip | 33549-3716
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Country | US
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Telephone | 813-501-7407
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Fax | 813-964-3113
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Authorized Official
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Title or Position | CEO
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Name | DR. OMAR CARDENAS
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Credential | MD
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Telephone | 813-501-7407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME76006
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License Number State | FL
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