Provider Demographics
NPI:1659004109
Name:CARDENAS, CRUZ MARTIN JR
Entity Type:Individual
Prefix:
First Name:CRUZ
Middle Name:MARTIN
Last Name:CARDENAS
Suffix:JR
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8290
Mailing Address - Fax:956-362-8295
Practice Address - Street 1:2821 MICHAELANGELO DR STE 204
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1423
Practice Address - Country:US
Practice Address - Phone:956-362-8290
Practice Address - Fax:956-362-8295
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant