Provider Demographics
NPI:1043037807
Name:CARDENAS REYES, DIANDRA TERESA
Entity type:Individual
Prefix:
First Name:DIANDRA
Middle Name:TERESA
Last Name:CARDENAS REYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 49TH ST N APT 907
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1545
Mailing Address - Country:US
Mailing Address - Phone:813-466-4610
Mailing Address - Fax:
Practice Address - Street 1:8400 49TH ST N APT 907
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1545
Practice Address - Country:US
Practice Address - Phone:813-466-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty