Provider Demographics
NPI:1639478274
Name:CARDONA, GLENDA M (PA - C)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:M
Last Name:CARDONA
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:M
Other - Last Name:CAPERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:9312B WOLFF AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-3212
Mailing Address - Country:US
Mailing Address - Phone:915-591-2080
Mailing Address - Fax:915-591-2080
Practice Address - Street 1:4501 N. MESA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-591-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105569363A00000X
FLPA3105569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant