Provider Demographics
NPI:1326688003
Name:CARDONA, ALEX REY
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:REY
Last Name:CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N ORANGE AVE APT 337
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1180
Mailing Address - Country:US
Mailing Address - Phone:407-757-6559
Mailing Address - Fax:877-538-5599
Practice Address - Street 1:777 N ORANGE AVE APT 337
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1180
Practice Address - Country:US
Practice Address - Phone:407-757-6559
Practice Address - Fax:877-538-5599
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty