Provider Demographics
NPI:1043650880
Name:CARDONA COMMERCIAL GROUP CORP.
Entity Type:Organization
Organization Name:CARDONA COMMERCIAL GROUP CORP.
Other - Org Name:GCC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-662-4957
Mailing Address - Street 1:10147 SW 53RD CT
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5619
Mailing Address - Country:US
Mailing Address - Phone:941-227-3662
Mailing Address - Fax:
Practice Address - Street 1:10147 SW 53RD CT
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-5619
Practice Address - Country:US
Practice Address - Phone:941-227-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier