Healthcare Provider Details

I. General information

NPI: 1396018867
Provider Name (Legal Business Name): JOSE F. CARDONA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 SW 97TH AVE SUITE A110
MIAMI FL
33165-2681
US

IV. Provider business mailing address

2740 SW 97TH AVE SUITE A110
MIAMI FL
33165-2681
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-8901
  • Fax: 786-558-8917
Mailing address:
  • Phone: 786-558-8901
  • Fax: 786-558-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME68785
License Number StateFL

VIII. Authorized Official

Name: JOSE F CARDONA
Title or Position: OWNER
Credential: MD
Phone: 786-558-8901