Provider Demographics
NPI:1205991437
Name:CARDENAS, MARY LOU
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LOUISA
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:403 E VILLARET
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-4144
Mailing Address - Country:US
Mailing Address - Phone:210-924-0609
Mailing Address - Fax:
Practice Address - Street 1:403 E VILLARET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-4144
Practice Address - Country:US
Practice Address - Phone:210-924-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114980310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility