Provider Demographics
NPI:1992193114
Name:SANTIAGO CARDENAS MD PA
Entity Type:Organization
Organization Name:SANTIAGO CARDENAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-282-2544
Mailing Address - Street 1:135 E 9TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4254
Mailing Address - Country:US
Mailing Address - Phone:786-282-2544
Mailing Address - Fax:
Practice Address - Street 1:135 E 9TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4254
Practice Address - Country:US
Practice Address - Phone:786-282-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty