Provider Demographics
NPI:1386204410
Name:CARDENAS, REYNALDO III
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:
Last Name:CARDENAS
Suffix:III
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 1:840 E KIKA DE LA GARZA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA JOYA
Mailing Address - State:TX
Mailing Address - Zip Code:78560-3905
Mailing Address - Country:US
Mailing Address - Phone:956-706-0858
Mailing Address - Fax:
Practice Address - Street 1:840 E KIKA DE LA GARZA BLVD
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-3905
Practice Address - Country:US
Practice Address - Phone:956-706-0858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No385H00000XRespite Care FacilityRespite Care