Provider Demographics
NPI:1467456897
Name:CARDONA, EMILIO RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:RENE
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 MAIN ST
Mailing Address - Street 2:STE 600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4515
Mailing Address - Country:US
Mailing Address - Phone:713-796-9993
Mailing Address - Fax:713-796-9419
Practice Address - Street 1:7515 MAIN ST
Practice Address - Street 2:STE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4515
Practice Address - Country:US
Practice Address - Phone:713-796-9993
Practice Address - Fax:713-796-9419
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE53532084P0800X, 2084P0802X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032576301Medicaid
TX032576301Medicaid
TXC14194Medicare UPIN