Provider Demographics
NPI:1932698651
Name:CARDONA RODRIGUEZ, CARLOS RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:RUBEN
Last Name:CARDONA RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CALLE SAN LORENZO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3223
Mailing Address - Country:US
Mailing Address - Phone:787-478-6018
Mailing Address - Fax:
Practice Address - Street 1:206 CALLE SAN LORENZO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3223
Practice Address - Country:US
Practice Address - Phone:787-478-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR21567208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program