Provider Demographics
NPI:1487706974
Name:CARDONA MUNOZ, VICTOR J (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:CARDONA MUNOZ
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 1:47A CALLE ALMENDRO
Mailing Address - Street 2:PUNTA LAS MARIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00913-4630
Mailing Address - Country:US
Mailing Address - Phone:787-728-6212
Mailing Address - Fax:787-728-8587
Practice Address - Street 1:611 MANUEL PAVIA FERNANDEZ ST.
Practice Address - Street 2:PAVIA MEDICAL PLAZA, SUITE 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-728-6212
Practice Address - Fax:787-728-8587
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11727208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8000653OtherHUMANA INSURANCE
PR080134OtherPROVIDER NO. CRUZ AZUL
PR0087765Medicare PIN
PR080134OtherPROVIDER NO. CRUZ AZUL