Provider Demographics
NPI:1407053606
Name:CARDONA PAIN & ANESTHESIA
Entity Type:Organization
Organization Name:CARDONA PAIN & ANESTHESIA
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-624-0702
Mailing Address - Street 1:1757 SW CABIN PL
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4213
Mailing Address - Country:US
Mailing Address - Phone:561-624-0702
Mailing Address - Fax:561-624-0773
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2788
Practice Address - Country:US
Practice Address - Phone:561-624-0702
Practice Address - Fax:561-624-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84122207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11542195OtherCAQH
FL1407053606OtherORGANIZATION NPI
FL1619915964OtherNPI PERONAL
FLAH762OtherMEDICARE PTAN
FLME84122OtherMEDICAL
FLH55817Medicare UPIN