Provider Demographics
NPI:1598731192
Name:CARDENAS, RAUL
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:CARDENAS
Suffix:
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 1:13941 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3002
Mailing Address - Country:US
Mailing Address - Phone:305-630-9244
Mailing Address - Fax:305-630-9223
Practice Address - Street 1:8358 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 202L
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7319
Practice Address - Country:US
Practice Address - Phone:305-630-9244
Practice Address - Fax:305-630-9223
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046093208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044356500Medicaid
FLD50461Medicare UPIN
FL02343Medicare ID - Type Unspecified