Provider Demographics
NPI:1205552072
Name:CARDONA, ANTONIO JR (NP)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:CARDONA
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 SEPULVEDA BLVD # 344
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2422
Mailing Address - Country:US
Mailing Address - Phone:818-741-5683
Mailing Address - Fax:
Practice Address - Street 1:15625 ODYSSEY DR UNIT 48
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3283
Practice Address - Country:US
Practice Address - Phone:818-741-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021581363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner