Provider Demographics
NPI:1073360046
Name:CARDENAS, CRISTINA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CC-SLP
Mailing Address - Street 1:3189 TINA DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3740
Mailing Address - Country:US
Mailing Address - Phone:830-325-5028
Mailing Address - Fax:
Practice Address - Street 1:2110 LOMAS DEL SUR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78046-5750
Practice Address - Country:US
Practice Address - Phone:956-712-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist