Basic Information
| Provider Information | |||||||||
| NPI: | 1497416135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARDENAS | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | ALICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15055 EAST FWY | ||||||||
| Address2: | |||||||||
| City: | CHANNELVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775304144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135175255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 W ADOUE ST | ||||||||
| Address2: | |||||||||
| City: | ALVIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775112718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2022 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F11210148 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.