Provider Demographics
NPI:1205858602
Name:CARDONA-GARCIA, OMAR DAVID (MD)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:DAVID
Last Name:CARDONA-GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OMAR
Other - Middle Name:DAVID
Other - Last Name:CARDONA-GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0547
Mailing Address - Country:US
Mailing Address - Phone:787-818-0300
Mailing Address - Fax:
Practice Address - Street 1:CARR 111 KM 2.3
Practice Address - Street 2:BO PALMAR INT
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-818-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR159262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology