Provider Demographics
NPI:1316369382
Name:CARDENAS, MAGDALENO RAFAEL JR
Entity Type:Individual
Prefix:
First Name:MAGDALENO
Middle Name:RAFAEL
Last Name:CARDENAS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11653 CEDAR CREST DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6534
Mailing Address - Country:US
Mailing Address - Phone:915-667-3548
Mailing Address - Fax:
Practice Address - Street 1:11653 CEDAR CREST DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6534
Practice Address - Country:US
Practice Address - Phone:915-667-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program