Provider Demographics
NPI:1528787009
Name:CARDONA MATIAS, TATIANA E (LCDA)
Entity type:Individual
Prefix:MISS
First Name:TATIANA
Middle Name:E
Last Name:CARDONA MATIAS
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22620 CALLE FELIPE MERCADO
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-7239
Mailing Address - Country:US
Mailing Address - Phone:787-452-4634
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 96.8 LOCAL 202
Practice Address - Street 2:BO COCOS
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9319
Practice Address - Country:US
Practice Address - Phone:787-895-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR103T00000XMedicaid