Provider Demographics
NPI:1679603583
Name:BAGUE CARDONA, CARMEN E (MT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:BAGUE CARDONA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A5 CALLE E
Mailing Address - Street 2:ELDORADO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3488
Mailing Address - Country:US
Mailing Address - Phone:787-274-1318
Mailing Address - Fax:787-274-1318
Practice Address - Street 1:33 - 17 AVE ROBERTO CLEMENTE
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-8349
Practice Address - Fax:787-252-8490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3151246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist