Healthcare Provider Details

I. General information

NPI: 1821243429
Provider Name (Legal Business Name): EDWIN CARDONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 AVE. CAMPO RICO COUNTRY CLUB
SAN JUAN PR
00924
US

IV. Provider business mailing address

1353 CARR. # 19 MSC # 364
GUAYNABO PR
00966-2701
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-0510
  • Fax: 787-257-1110
Mailing address:
  • Phone: 787-748-4102
  • Fax: 787-748-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number1909
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: