Provider Demographics
NPI:1366440364
Name:CARDONA-TRAVERZO, EDGAR AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:AUGUSTO
Last Name:CARDONA-TRAVERZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0337
Mailing Address - Country:US
Mailing Address - Phone:787-638-9705
Mailing Address - Fax:787-285-8844
Practice Address - Street 1:FONT MATELO AVE 355, RYDER MEDICAL & PROFESSIONAL BLDG
Practice Address - Street 2:SUITE 213
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-638-9705
Practice Address - Fax:787-656-5809
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE28215Medicare UPIN
PR81730Medicare PIN