Healthcare Provider Details

I. General information

NPI: 1427433820
Provider Name (Legal Business Name): JOSE M CARDONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 CALLE JUAN J JIMENEZ
SAN JUAN PR
00918-2605
US

IV. Provider business mailing address

516 CALLE JUAN J JIMENEZ
SAN JUAN PR
00918-2605
US

V. Phone/Fax

Practice location:
  • Phone: 787-940-4094
  • Fax:
Mailing address:
  • Phone: 787-940-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21250
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: