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General NPI Number Information
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NPI Number | 1376703710
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Entity Type | Individual
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Provider Name | MARYLYNN CARDONA MD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 4403 HARRISON BLVD STE 4650
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City | OGDEN
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State | UT
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Zip | 84403-3271
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Country | US
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Telephone | 801-475-3240
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Fax | 801-475-3241
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Provider Business Mailing Address
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Address Line | 4650 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-4303
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Country | US
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Telephone | 801-475-3000
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Fax | 801-475-3241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 7780693-1205
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License Number State | UT
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