Provider Demographics
NPI:1306958699
Name:CARDONA, CHRISTINE SEVERANCE (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SEVERANCE
Last Name:CARDONA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19841 N. 27TH AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4002
Mailing Address - Country:US
Mailing Address - Phone:602-942-8512
Mailing Address - Fax:602-942-1075
Practice Address - Street 1:19841 N. 27TH AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4002
Practice Address - Country:US
Practice Address - Phone:602-942-8512
Practice Address - Fax:602-942-1075
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9613207Q00000X
AZ005319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine