Healthcare Provider Details

I. General information

NPI: 1831169846
Provider Name (Legal Business Name): HERNANDO A CARDONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 PARK CENTER DR SUITE 2D
ORLANDO FL
32835-5794
US

IV. Provider business mailing address

1515 PARK CENTER DR SUITE 2D
ORLANDO FL
32835-5794
US

V. Phone/Fax

Practice location:
  • Phone: 407-704-6912
  • Fax: 407-704-6913
Mailing address:
  • Phone: 407-704-6912
  • Fax: 407-704-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 88235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: