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NPI Code Detail

MEDICARE: DR. JING-JING MAMABA CARDONA M.D.

MEDICARE: DR. JING-JING MAMABA CARDONA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QB0002XObesity Medicine (Family Medicine) Physician89992241FL
2207Q00000XFamily Medicine PhysicianME111613FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01201933OTHERFLRR MEDICARE

General Provider Information

NPI Number : 1457331415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JING-JING MAMABA CARDONA M.D.
Provider Business Mailing Address
First Line : 10175 FORTUNE PKWY UNIT 1101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6757
Country : US
Telephone Number : 904-551-4625
Fax Number : 904-990-1491
Provider Business Practice Location Address
First Line : 10175 FORTUNE PKWY UNIT 1101
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6757
Country : US
Telephone Number : 904-551-4625
Fax Number : 904-990-1491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 06/22/2025

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