Provider Demographics
NPI:1922036730
Name:CARDONA MEDICAL CENTER, INCORPORATED
Entity Type:Organization
Organization Name:CARDONA MEDICAL CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-548-3301
Mailing Address - Street 1:1390 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3704
Mailing Address - Country:US
Mailing Address - Phone:305-548-3301
Mailing Address - Fax:305-548-3032
Practice Address - Street 1:1390 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3704
Practice Address - Country:US
Practice Address - Phone:305-548-3301
Practice Address - Fax:305-548-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96664OtherBLUE CROSS BLUE SHIELD
FL96664XMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FLK4456Medicare ID - Type UnspecifiedGROUP NUMBER
FLD63937Medicare UPIN