Provider Demographics
NPI:1689797482
Name:CADENA, GARY D (CCP, FA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:CADENA
Suffix:
Gender:M
Credentials:CCP, FA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14611 STAR CROSS TRL
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4051
Mailing Address - Country:US
Mailing Address - Phone:210-695-8900
Mailing Address - Fax:210-695-5544
Practice Address - Street 1:14611 STAR CROSS TRL
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4051
Practice Address - Country:US
Practice Address - Phone:210-695-8900
Practice Address - Fax:210-695-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0302174400000X, 242T00000X
246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No174400000XOther Service ProvidersSpecialist
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist