Provider Demographics
NPI:1316369382
Name:CARDENAS, MAGDALENO RAFAEL JR (MD)
Entity type:Individual
Prefix:
First Name:MAGDALENO
Middle Name:RAFAEL
Last Name:CARDENAS
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1373 COPPER GATE PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7263
Mailing Address - Country:US
Mailing Address - Phone:915-667-3548
Mailing Address - Fax:
Practice Address - Street 1:12220 RC POE RD STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4921
Practice Address - Country:US
Practice Address - Phone:915-221-0289
Practice Address - Fax:915-221-0284
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty