Provider Demographics
NPI:1265466759
Name:CARDONA, DAVID WAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:CARDONA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1300 N FRESNO ST
Mailing Address - Street 2:STE 220
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3843
Mailing Address - Country:US
Mailing Address - Phone:559-495-6745
Mailing Address - Fax:559-495-6705
Practice Address - Street 1:1300 N FRESNO ST
Practice Address - Street 2:SUITE #220
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3843
Practice Address - Country:US
Practice Address - Phone:559-495-6758
Practice Address - Fax:559-495-6788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-12-31
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Provider Licenses
StateLicense IDTaxonomies
CAG69949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF37898Medicare UPIN