Provider Demographics
NPI:1194358861
Name:CARDONA-DE JESUS, CRISTINA ELISA
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ELISA
Last Name:CARDONA-DE JESUS
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:CALLE CARLOS I # I1
Mailing Address - Street 2:MANSIONES REALES
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-313-1776
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSIDAD CENTRAL DEL CARIBE
Practice Address - Street 2:AVE. LAUREL, SANTA JUANITA,
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-313-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program