Healthcare Provider Details

I. General information

NPI: 1922877992
Provider Name (Legal Business Name): JENNELY CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 10/06/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2-6 MUNOZ RIVERA FERRER ST
GUAYNABO PR
00969-3606
US

IV. Provider business mailing address

G9 CALLE LIRIO URB CARIBE GARDENS
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-7304
  • Fax:
Mailing address:
  • Phone: 787-469-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1820
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number88329
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: