Provider Demographics
NPI:1265411037
Name:CARDONA-RODRIGUEZ, MARIA MERCEDES (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MERCEDES
Last Name:CARDONA-RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109PASEO LAS VISTAS
Mailing Address - Street 2:FIRST ST
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-720-8600
Mailing Address - Fax:787-720-8600
Practice Address - Street 1:505 ROOSEVELT ST
Practice Address - Street 2:URB LA CUMBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-720-8600
Practice Address - Fax:787-720-8600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR060402084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
9 8417Medicare ID - Type Unspecified
D26705Medicare UPIN