Provider Demographics
NPI:1073568143
Name:CARDENAS, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 NW 82ND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6655
Mailing Address - Country:US
Mailing Address - Phone:786-953-7651
Mailing Address - Fax:786-953-6847
Practice Address - Street 1:3785 NW 82ND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6655
Practice Address - Country:US
Practice Address - Phone:786-953-7651
Practice Address - Fax:786-953-6847
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061716A207VX0000X
GA63838207VG0400X
FLME109915207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology