Provider Demographics
NPI:1508493560
Name:CARDENAS PENA, MERCEDES ANDREINA (DO)
Entity Type:Individual
Prefix:MISS
First Name:MERCEDES
Middle Name:ANDREINA
Last Name:CARDENAS PENA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6530 108TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2201
Mailing Address - Country:US
Mailing Address - Phone:909-231-5380
Mailing Address - Fax:
Practice Address - Street 1:7049 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1033
Practice Address - Country:US
Practice Address - Phone:718-280-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QU0200X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty