Healthcare Provider Details

I. General information

NPI: 1689819013
Provider Name (Legal Business Name): ENOC CARDONA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15C CALLE DR BASORA N
MAYAGUEZ PR
00680-4833
US

IV. Provider business mailing address

HC 6 BOX 60959
MAYAGUEZ PR
00680-9557
US

V. Phone/Fax

Practice location:
  • Phone: 787-805-5342
  • Fax:
Mailing address:
  • Phone: 787-431-5296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1159702
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number145584
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7655
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11031977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: