Provider Demographics
NPI:1427219336
Name:CARDENAS, SERGIO (MT)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 SW 200TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1333
Mailing Address - Country:US
Mailing Address - Phone:305-969-2718
Mailing Address - Fax:305-969-2718
Practice Address - Street 1:10370 SW 200TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1333
Practice Address - Country:US
Practice Address - Phone:305-969-2718
Practice Address - Fax:305-969-2718
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39839225700000X
FL3747A0650X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687610296Medicaid
FL687610298Medicaid
FL687610205Medicaid