Provider Demographics
NPI:1699855916
Name:CARDENAS, JUAN JAVIER (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:JAVIER
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SILVER STAR RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-4245
Mailing Address - Country:US
Mailing Address - Phone:407-291-9023
Mailing Address - Fax:407-290-9501
Practice Address - Street 1:6200 SILVER STAR RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-4245
Practice Address - Country:US
Practice Address - Phone:407-291-9023
Practice Address - Fax:407-290-9501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39538207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067961500Medicaid
FL273827900Medicaid
FLD55105Medicare UPIN
FLK9465Medicare PIN
FL47569ZMedicare PIN