MEDICARE: AMILCAR FABIAN CARDONA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	4301108523	MI
2	2083X0100X	Occupational Medicine Physician	A145248	CA
3	2083X0100X	Occupational Medicine Physician	9857459	UT

General Provider Information

NPI Number	:	1841618956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMILCAR FABIAN CARDONA M.D.

Provider Business Mailing Address
First Line	:	6600 BRUCEVILLE RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4671
Country	:	US
Telephone Number	:	916-866-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	391 S CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1263
Country	:	US
Telephone Number	:	801-581-4800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	02/11/2022

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