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General NPI Number Information
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NPI Number | 1851996573
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Entity Type | Individual
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Provider Name | PETRA CARDONA PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 2405 SHADELANDS DR STE 300
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City | WALNUT CREEK
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State | CA
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Zip | 94598-5906
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Country | US
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Telephone | 925-939-8585
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31396
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City | WALNUT CREEK
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State | CA
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Zip | 94598-8396
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Country | US
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Telephone | 925-939-8585
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | PA58526
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 58526
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA58526
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License Number State | CA
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