Provider Demographics
NPI:1164520250
Name:CARDONA, ILEANA (TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0990
Mailing Address - Country:US
Mailing Address - Phone:787-376-1997
Mailing Address - Fax:
Practice Address - Street 1:URB JARDINES YABUCOA
Practice Address - Street 2:CALLE 1 A8
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-6709
Practice Address - Fax:787-266-6505
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4557183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4557OtherTECHNICIAN