Provider Demographics
NPI:1174328900
Name:ALFONSO CARDENAS, JESUS DAVID
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:DAVID
Last Name:ALFONSO CARDENAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4738
Mailing Address - Country:US
Mailing Address - Phone:561-528-6499
Mailing Address - Fax:
Practice Address - Street 1:1431 W 37TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4738
Practice Address - Country:US
Practice Address - Phone:561-528-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1193940106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician