Provider Demographics
NPI:1194936112
Name:CARDONA, NESJUAN FAELIO
Entity type:Individual
Prefix:
First Name:NESJUAN
Middle Name:FAELIO
Last Name:CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1622
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1622
Mailing Address - Country:US
Mailing Address - Phone:787-896-6586
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:CARR #2 KM 141.1 AVE. KENNEDY
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15155208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice