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General NPI Number Information
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NPI Number | 1760885180
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Entity Type | Organization
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Legal Business Name | DR. DODANID CARDONA MEDINA CSP
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 02/18/2019
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Provider Practice Location Address
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Address Line | CENTRO AMBULATORIO HIMMA SAN PABLO CAGUAS PISO G AVE LUIS MUNOZ RIVERA A-1
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-668-7236
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Fax |
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Provider Business Mailing Address
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Address Line | 76 VIA DEL SOL
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City | CAGUAS
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State | PR
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Zip | 00727-3105
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Country | US
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Telephone | 787-550-7555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DODANID CARDONA
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Credential |
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Telephone | 787-550-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15339
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License Number State | PR
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