Provider Demographics
NPI:1144418674
Name:CARDONA, AIDA S
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:S
Last Name:CARDONA
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:ASSMCA
Mailing Address - Street 2:AVE. BARBOSA #414
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-1414
Mailing Address - Country:US
Mailing Address - Phone:787-638-4028
Mailing Address - Fax:
Practice Address - Street 1:ASSMCA AVE. BARBOSA # 414
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00928-1414
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical