MEDICARE: SERGIO CARDENAS MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA39839	FL
2	3747A0650X	Attendant Care Provider		FL
3	3747P1801X	Personal Care Attendant		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427219336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO CARDENAS MT

Provider Business Mailing Address
First Line	:	10370 SW 200TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1333
Country	:	US
Telephone Number	:	305-969-2718
Fax Number	:	305-969-2718

Provider Business Practice Location Address
First Line	:	10370 SW 200TH TER
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1333
Country	:	US
Telephone Number	:	305-969-2718
Fax Number	:	305-969-2718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/23/2008

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