Healthcare Provider Details

I. General information

NPI: 1407551583
Provider Name (Legal Business Name): JENNIFER CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7000
  • Fax:
Mailing address:
  • Phone: 281-917-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW3486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: