Healthcare Provider Details

I. General information

NPI: 1477283836
Provider Name (Legal Business Name): CHRISTIAN JOSE CARDONA-GONZALEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CALLE MENDEZ VIGO STE 204
DORADO PR
00646-4801
US

IV. Provider business mailing address

410 CALLE MENDEZ VIGO STE 204
DORADO PR
00646-4801
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-1464
  • Fax:
Mailing address:
  • Phone: 787-796-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23549
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: