Provider Demographics
NPI:1396018867
Name:JOSE F. CARDONA MD PA
Entity Type:Organization
Organization Name:JOSE F. CARDONA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-558-8901
Mailing Address - Street 1:2740 SW 97TH AVE
Mailing Address - Street 2:SUITE A110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2681
Mailing Address - Country:US
Mailing Address - Phone:786-558-8901
Mailing Address - Fax:786-558-8917
Practice Address - Street 1:2740 SW 97TH AVE
Practice Address - Street 2:SUITE A110
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2681
Practice Address - Country:US
Practice Address - Phone:786-558-8901
Practice Address - Fax:786-558-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68785261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care