Healthcare Provider Details

I. General information

NPI: 1972418523
Provider Name (Legal Business Name): CCARDONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/11/2026
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

446 LA CEIBA
CAMUY PR
00627
US

V. Phone/Fax

Practice location:
  • Phone: 787-796-1464
  • Fax: 787-278-3338
Mailing address:
  • Phone: 787-402-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN JOSE CARDONA-GONZALEZ
Title or Position: FAMILY MEDICINE
Credential: MD
Phone: 787-402-3100