Healthcare Provider Details

I. General information

NPI: 1831898683
Provider Name (Legal Business Name): OMAR ALEJANDRO CARDONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 NELSON RD
OCEANSIDE CA
92058
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 760-763-8527
  • Fax:
Mailing address:
  • Phone: 571-231-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102208871
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: