Healthcare Provider Details

I. General information

NPI: 1194721258
Provider Name (Legal Business Name): OSCAR ANTONIO CARDONA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43-15 AVE MAIN
BAYAMON PR
00959-6501
US

IV. Provider business mailing address

43-15MAIN AVENUE SANTA ROSA
BAYA,MON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-4550
  • Fax: 787-798-4335
Mailing address:
  • Phone: 787-798-4550
  • Fax: 787-798-4335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5382
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: