Provider Demographics
NPI:1962026088
Name:CARDENAS, HENRY SR
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:CARDENAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 SW 131ST CT APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5289
Mailing Address - Country:US
Mailing Address - Phone:786-523-4136
Mailing Address - Fax:
Practice Address - Street 1:6214 SW 131ST CT APT 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5289
Practice Address - Country:US
Practice Address - Phone:786-523-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician