Provider Demographics
NPI:1477760759
Name:CARDONA, MYRNA YARITZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:YARITZA
Last Name:CARDONA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HR27 AVE EL COMANDANTE
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-2771
Mailing Address - Country:US
Mailing Address - Phone:787-276-2155
Mailing Address - Fax:787-276-2155
Practice Address - Street 1:HR27 AVE EL COMANDANTE
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2771
Practice Address - Country:US
Practice Address - Phone:787-276-2155
Practice Address - Fax:787-276-2155
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice