Provider Demographics
NPI:1164861977
Name:CARDENAL, DENISE AZUCENA VILCHEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:AZUCENA VILCHEZ
Last Name:CARDENAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:AZUCENA
Other - Last Name:VILCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12554 SW KEY DEER LN
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-6408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7205
Practice Address - Country:US
Practice Address - Phone:561-263-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133568207V00000X
MO2013042440207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021893700Medicaid