Provider Demographics
NPI:1194721258
Name:CARDONA, OSCAR ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:ANTONIO
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43-15MAIN AVENUE
Mailing Address - Street 2:SANTA ROSA
Mailing Address - City:BAYA,MON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-798-4550
Mailing Address - Fax:787-798-4335
Practice Address - Street 1:43-15 AVE MAIN
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6501
Practice Address - Country:US
Practice Address - Phone:787-798-4550
Practice Address - Fax:787-798-4335
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28244OtherTRIPLE S
PR096060OtherFHS
PR068758OtherLA CRUZ AZUL DE PR
PR28244Medicare ID - Type UnspecifiedNON PARTICIPANT PROVIDER