Provider Demographics
NPI:1063172948
Name:CARDONA, NELIDA
Entity type:Individual
Prefix:
First Name:NELIDA
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.ESTANCIAS DE MONTERIO #48
Mailing Address - Street 2:E 11 MIRAMELINDA ST
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-981-2386
Mailing Address - Fax:
Practice Address - Street 1:URB.ESTANCIAS DE MONTERIO #48
Practice Address - Street 2:E 11 MIRAMELINDA ST
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-981-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5933183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician