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General NPI Number Information
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NPI Number | 1245578244
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Entity Type | Organization
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Legal Business Name | GUSTAVO A CARDENAS MD PA
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Dates
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Enumeration Date | 01/25/2013
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 11195 S JOG RD SUITE 6
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-1829
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Country | US
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Telephone | 954-817-1445
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Fax |
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Provider Business Mailing Address
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Address Line | 9142 DUPONT PL
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City | WELLINGTON
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State | FL
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Zip | 33414-6476
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Country | US
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Telephone | 954-817-1445
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUSTAVO A CARDENAS
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Credential | M.D.
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Telephone | 954-817-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | ME101884
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME101884
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License Number State | FL
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