Provider Demographics
NPI:1619734936
Name:CARDENTEY, JACKLIN B
Entity Type:Individual
Prefix:
First Name:JACKLIN
Middle Name:B
Last Name:CARDENTEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACKLIN
Other - Middle Name:B
Other - Last Name:VILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5702 BALDWIN ELM ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7090
Mailing Address - Country:US
Mailing Address - Phone:786-426-7855
Mailing Address - Fax:
Practice Address - Street 1:5702 BALDWIN ELM ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7090
Practice Address - Country:US
Practice Address - Phone:786-426-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program