Provider Demographics
NPI:1245238203
Name:CARDENAS, SANTIAGO A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:A
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 1:135 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4254
Mailing Address - Country:US
Mailing Address - Phone:305-882-1100
Mailing Address - Fax:305-887-3273
Practice Address - Street 1:881 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4205
Practice Address - Country:US
Practice Address - Phone:305-882-1100
Practice Address - Fax:305-887-3273
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81032208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257389000Medicaid
H01577Medicare UPIN
FL257389000Medicaid