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General NPI Number Information
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NPI Number | 1669091088
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Entity Type | Individual
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Provider Name | CAROLINA MICHELLE VICENS CARDONA MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 431 AVE HOSTOS
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City | SAN JUAN
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State | PR
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Zip | 00918-3014
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Country | US
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Telephone | 787-704-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-9093
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 72114
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 24121
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License Number State | PR
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