Provider Demographics
NPI:1124512082
Name:CENDAN, MARIO (NP)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:CENDAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 S LAKELINE BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4660
Mailing Address - Country:US
Mailing Address - Phone:512-553-1921
Mailing Address - Fax:
Practice Address - Street 1:1905 S LAKELINE BLVD STE 4
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4660
Practice Address - Country:US
Practice Address - Phone:512-553-1921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137701363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology