Provider Demographics
NPI:1841780103
Name:HUESCA CARDOSA, ALEJANDRO (SA-C)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:HUESCA CARDOSA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 N ASTER ST
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3806
Mailing Address - Country:US
Mailing Address - Phone:956-588-3115
Mailing Address - Fax:
Practice Address - Street 1:612 N ASTER ST
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-3806
Practice Address - Country:US
Practice Address - Phone:956-588-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18-224246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant