Provider Demographics
NPI:1043420433
Name:CARDONA, AGNES ILEANA
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:ILEANA
Last Name:CARDONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NUEVAS VILLAS DEL MANATI AVE. LAS PALMAS APTDO 250
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-5586
Mailing Address - Fax:
Practice Address - Street 1:CFSE URB. CORDOVA DAVILA CARR. #2 INTERIOR
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-2495
Practice Address - Fax:787-884-4009
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12354208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice