Provider Demographics
NPI:1760063317
Name:MARTINEZ-CARDENAS, TANYA SUSETTE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SUSETTE
Last Name:MARTINEZ-CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BRAZOS LN
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-5289
Mailing Address - Country:US
Mailing Address - Phone:512-775-1027
Mailing Address - Fax:
Practice Address - Street 1:26229 N CRANES MILL RD
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-1957
Practice Address - Country:US
Practice Address - Phone:830-935-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)