Provider Demographics
NPI:1497422984
Name:DR CARLOS CARDENAS PLLC
Entity Type:Organization
Organization Name:DR CARLOS CARDENAS PLLC
Other - Org Name:DR C VIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-260-7102
Mailing Address - Street 1:609 GRANDVIEW PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5417
Mailing Address - Country:US
Mailing Address - Phone:210-413-8890
Mailing Address - Fax:
Practice Address - Street 1:1303 MCCULLOUGH AVE STE 533
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5607
Practice Address - Country:US
Practice Address - Phone:210-465-5545
Practice Address - Fax:210-742-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty