Healthcare Provider Details

I. General information

NPI: 1598976979
Provider Name (Legal Business Name): JOSE A ISADO ZARDON DR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE A ISADO ZARDON MD

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

I STREET # 20 VILLA CAPARRA NORTE
GUAYNABO PR
00966
US

IV. Provider business mailing address

I STREET # 20 VILLA CAPARRA NORTE
GUAYNABO PR
00966
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-5513
  • Fax: 787-771-7394
Mailing address:
  • Phone: 787-781-5513
  • Fax: 787-771-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4656
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: