Provider Demographics
NPI:1598116246
Name:CARDENAS, JIMMY (DME)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-4643
Mailing Address - Country:US
Mailing Address - Phone:210-785-8112
Mailing Address - Fax:210-785-8113
Practice Address - Street 1:1717 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-4643
Practice Address - Country:US
Practice Address - Phone:210-785-8112
Practice Address - Fax:210-785-8113
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies