Provider Demographics
NPI:1164208773
Name:CARDOZO, XAVIELA
Entity Type:Individual
Prefix:
First Name:XAVIELA
Middle Name:
Last Name:CARDOZO
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 1:100 KINGS POINT DR APT 1714
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4731
Mailing Address - Country:US
Mailing Address - Phone:786-819-8359
Mailing Address - Fax:
Practice Address - Street 1:100 KINGS POINT DR APT 1714
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4731
Practice Address - Country:US
Practice Address - Phone:786-819-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-595363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical