Provider Demographics
NPI:1366447963
Name:CARDONA, DODANID (MD)
Entity Type:Individual
Prefix:DR
First Name:DODANID
Middle Name:
Last Name:CARDONA
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 1:76 VIA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3105
Mailing Address - Country:US
Mailing Address - Phone:787-550-7555
Mailing Address - Fax:
Practice Address - Street 1:CENTRO AMBULATORIO HIMA SAN PABLO PISO G
Practice Address - Street 2:A1 AVE LUIS MUNOZ RIVERA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-668-7236
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153392084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-3002Medicare ID - Type Unspecified
PRI-26595Medicare UPIN