Provider Demographics
NPI:1932107695
Name:CARDONA, JOSE FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FRANCISCO
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:F
Other - Last Name:CARDONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, JD, MBA, MHA
Mailing Address - Street 1:PO BOX 162900
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-2900
Mailing Address - Country:US
Mailing Address - Phone:786-558-8901
Mailing Address - Fax:786-558-8917
Practice Address - Street 1:2740 SW 97TH AVE
Practice Address - Street 2:SUITE 110A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2681
Practice Address - Country:US
Practice Address - Phone:786-558-8901
Practice Address - Fax:786-558-8917
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68785208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD-34203Medicare UPIN