Provider Demographics
NPI:1780402719
Name:CARDENAS VALDES, CARLOS ALBERTO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALBERTO
Last Name:CARDENAS VALDES
Suffix:
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 1:1350 GREEN VALLEY CIR UNIT 1503
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-4638
Mailing Address - Country:US
Mailing Address - Phone:239-428-5202
Mailing Address - Fax:
Practice Address - Street 1:1350 GREEN VALLEY CIR UNIT 1503
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-4638
Practice Address - Country:US
Practice Address - Phone:239-428-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician