Provider Demographics
NPI:1558642777
Name:CARDONA, CHRISTIAN (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:CARDONA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EL CONQUISTADOR
Mailing Address - Street 2:CALLE 5 L-54
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-667-4430
Mailing Address - Fax:787-761-3840
Practice Address - Street 1:EL CONQUISTADOR
Practice Address - Street 2:ST. 5 L-54
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-667-4430
Practice Address - Fax:787-761-3840
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17252164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17252OtherNURSE