Provider Demographics
NPI:1114308350
Name:CARDONA, CAROLYN (MS, RD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 E SPAULDING AVE
Mailing Address - Street 2:UNIT 105
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-5200
Mailing Address - Country:US
Mailing Address - Phone:719-582-3400
Mailing Address - Fax:
Practice Address - Street 1:3117 E SPAULDING AVE
Practice Address - Street 2:UNIT 105
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-5200
Practice Address - Country:US
Practice Address - Phone:719-592-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1019829133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered