Provider Demographics
NPI:1376325951
Name:CARDONA, GONZALO
Entity Type:Individual
Prefix:
First Name:GONZALO
Middle Name:
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 1:755 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1626
Mailing Address - Country:US
Mailing Address - Phone:386-226-0011
Mailing Address - Fax:386-226-0013
Practice Address - Street 1:4873 PALM COAST PKWY NW UNIT 2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3669
Practice Address - Country:US
Practice Address - Phone:386-226-0011
Practice Address - Fax:386-226-0013
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-14740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor