Provider Demographics
NPI:1447322839
Name:DE CARDENAS & VILLALONGA MDS PA
Entity type:Organization
Organization Name:DE CARDENAS & VILLALONGA MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:DE CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-662-8316
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8316
Mailing Address - Fax:305-663-8513
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8316
Practice Address - Fax:305-663-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0024200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277588300Medicaid
FLD27695Medicare UPIN
FLD79902Medicare UPIN
FLI67627Medicare UPIN