Provider Demographics
NPI:1316206865
Name:CARDENAS, MARISOL (LMT)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13366 NW 3RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1605
Mailing Address - Country:US
Mailing Address - Phone:786-278-1522
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 97TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1494
Practice Address - Country:US
Practice Address - Phone:305-670-0055
Practice Address - Fax:305-670-0054
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67119225700000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist