Healthcare Provider Details

I. General information

NPI: 1548478779
Provider Name (Legal Business Name): MARIA EUGENIA CARDONA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 SW 158TH PL
MIAMI FL
33193-3608
US

IV. Provider business mailing address

6856 SW 158TH PL
MIAMI FL
33193-3608
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-6956
  • Fax:
Mailing address:
  • Phone: 786-252-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPMH 750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: