Provider Demographics
NPI:1629067707
Name:CARDONA, CARLOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:CARDONA BADILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:CARRETERA 110 KM 0.9
Mailing Address - Street 2:BARRIO CEIBA BAJA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-891-0055
Mailing Address - Fax:
Practice Address - Street 1:CARR 110 KM 0.9
Practice Address - Street 2:BA CEIBA BAJA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR015983208D00000X
PR15983208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI42675Medicare UPIN