Provider Demographics
NPI:1942569694
Name:CARDENAS, TATIANA CARLA PEREIRA (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:CARLA PEREIRA
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1500 RED RIVER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1918
Mailing Address - Country:US
Mailing Address - Phone:305-479-8284
Mailing Address - Fax:
Practice Address - Street 1:1601 TRINITY ST STE 704F
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-7873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR2550208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372917001Medicaid
TX372917002OtherCSHCN