Provider Demographics
NPI:1376834820
Name:CARDONA-GRAU, DIANA
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:CARDONA-GRAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2911
Mailing Address - Country:US
Mailing Address - Phone:321-843-9017
Mailing Address - Fax:321-843-9019
Practice Address - Street 1:1725 COOK AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2911
Practice Address - Country:US
Practice Address - Phone:321-843-9017
Practice Address - Fax:321-843-9019
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1354802088P0231X
TXV67742088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024234100Medicaid