Provider Demographics
NPI:1598976979
Name:ISADO ZARDON, JOSE A (DR)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:ISADO ZARDON
Suffix:
Gender:M
Credentials:DR
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:ISADO ZARDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:I STREET # 20 VILLA CAPARRA NORTE
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-781-5513
Mailing Address - Fax:787-771-7394
Practice Address - Street 1:I STREET # 20 VILLA CAPARRA NORTE
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-781-5513
Practice Address - Fax:787-771-7394
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4656OtherPEDIATRICIAN LICENCE