=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740643360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CESAR CARDENAS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2016
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 WALLACE BLVD STE 106
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-414-9970
-----------------------------------------------------
Fax | 806-351-3783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 S COULTER ST
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-414-9970
-----------------------------------------------------
Fax | 806-351-3783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | T4720
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------