Provider Demographics
NPI:1619050523
Name:CARDONA, MARIA ISABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ISABEL
Last Name:CARDONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 CALLE DR PAVIA FERNANDEZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2239
Mailing Address - Country:US
Mailing Address - Phone:787-726-9048
Mailing Address - Fax:787-726-7444
Practice Address - Street 1:611 CALLE DR PAVIA FERNANDEZ
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-726-9048
Practice Address - Fax:787-726-7444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF39289Medicare UPIN