Provider Demographics
NPI:1528572708
Name:CARDONA, CHRISTOPHER ALEXANDER
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALEXANDER
Last Name:CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9778 SW 220TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1542
Mailing Address - Country:US
Mailing Address - Phone:786-348-5392
Mailing Address - Fax:
Practice Address - Street 1:9778 SW 220TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1542
Practice Address - Country:US
Practice Address - Phone:786-348-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician