Provider Demographics
NPI:1356449185
Name:CARDONA RIVERA, EMILIA DEL C (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:DEL C
Last Name:CARDONA RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:EMILIA
Other - Middle Name:
Other - Last Name:CARDONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:218 DR FERNANDEZ ST
Mailing Address - Street 2:P-2
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-755-7170
Mailing Address - Fax:
Practice Address - Street 1:218 DR FERNANDEZ ST
Practice Address - Street 2:P-2
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-755-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
041555OtherCRUZ AZUL
41790OtherSSS
9760008OtherHUMANA
4077OtherFIRST MEDICAL HEALTH PLAN
206480OtherPREFERRED HEALTH UTI