MEDICARE: MARIANNA CARDENAS-FERNANDEZ MD

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	207Q00000X	Family Medicine Physician	T9360	TX

General Provider Information

NPI Number	:	1851957989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNA CARDENAS-FERNANDEZ MD

Provider Business Mailing Address
First Line	:	5219 CITY BANK PKWY STE 35
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79407-3545
Country	:	US
Telephone Number	:	806-761-0334
Fax Number	:	806-785-0872

Provider Business Practice Location Address
First Line	:	14615 SAN PEDRO AVE STE 218-220
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4321
Country	:	US
Telephone Number	:	210-644-3650
Fax Number	:	210-702-6979

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	06/30/2026

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