Provider Demographics
NPI:1528211505
Name:CARDOVA, LAURA (LND)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:CARDOVA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C39 URB. ENRAMADA
Mailing Address - Street 2:CALL CAMINO DE NARDOS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:787-756-8907
Practice Address - Street 1:C39 URB. ENRAMADA
Practice Address - Street 2:CALL CAMINO DE NARDOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-756-8907
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR782133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist