Provider Demographics
NPI:1962182303
Name:CARDENAS JIMENEZ, FEDERICO
Entity type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:CARDENAS JIMENEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 S CRYSTAL LAKE DR APT 75
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8805
Mailing Address - Country:US
Mailing Address - Phone:239-747-3284
Mailing Address - Fax:
Practice Address - Street 1:1610 S CRYSTAL LAKE DR APT 75
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8805
Practice Address - Country:US
Practice Address - Phone:239-747-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA102724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist