Basic Information
| Provider Information | |||||||||
| NPI: | 1881997138 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CADENA | ||||||||
| FirstName: | ALMA | ||||||||
| MiddleName: | DELIA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 841656 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752841656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035315000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5414 S BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757031335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035811601 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2010 | ||||||||
| LastUpdateDate: | 10/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA05940 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 75-0818167-048 | 01 | TX | TRICARE | OTHER | 220471101 | 05 | TX | MEDICAID | 75-0818167-015 | 01 | TX | TRICARE | OTHER | 75-2616977-001 | 01 | TX | TRICARE | OTHER | 752616977002 | 01 | TX | TRICARE | OTHER | 8811NF | 01 | TX | BCBS | OTHER | 220471103 | 05 | TX | MEDICAID | 75-0218167-044 | 01 | TX | TRICARE | OTHER | 8282ND | 01 | TX | BCBS BLUE | OTHER | 835N38 | 01 | TX | BCBS | OTHER | P01276466 | 01 | TX | RAIL ROAD | OTHER | TIN PLUS 022 | 01 | TX | TRICARE | OTHER | 75-2616977-028 | 01 | TX | TRICARE | OTHER | 75-1976930-005 | 01 | TX | TRICARE | OTHER | 220471102 | 05 | TX | MEDICAID | 220471104 | 05 | TX | MEDICAID | P0181261 | 01 | TX | RAIL ROAD | OTHER |