Provider Demographics
NPI:1790895647
Name:CARDONA, SIGIFREDO
Entity Type:Individual
Prefix:
First Name:SIGIFREDO
Middle Name:
Last Name:CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX MSC 442
Mailing Address - Street 2:PO BOX 4035
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614
Mailing Address - Country:US
Mailing Address - Phone:787-817-3996
Mailing Address - Fax:787-816-9310
Practice Address - Street 1:101 CALLE FCO GONZALO MARIN
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4754
Practice Address - Country:US
Practice Address - Phone:787-817-3996
Practice Address - Fax:787-816-9310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5294207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79606Medicare UPIN
2700Medicare ID - Type Unspecified