Provider Demographics
NPI:1407060379
Name:CARDONA ROLDAN, CARLOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:CARDONA ROLDAN
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:CARLOS I #I-1 MANSIONES REALES
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-789-1486
Mailing Address - Fax:787-723-2044
Practice Address - Street 1:1492 AVE. PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-722-2845
Practice Address - Fax:787-723-2044
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF07470Medicare UPIN
PR82637Medicare ID - Type Unspecified