Provider Demographics
NPI:1609163393
Name:CARDONA, JORGE JR (OT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CARDONA
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 MESCAL LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8498
Mailing Address - Country:US
Mailing Address - Phone:915-545-3422
Mailing Address - Fax:
Practice Address - Street 1:1521 MESCAL LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8498
Practice Address - Country:US
Practice Address - Phone:915-545-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2814225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist