Basic Information
| Provider Information | |||||||||
| NPI: | 1104864693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDENO | ||||||||
| FirstName: | CORAZON | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ESPELETA | ||||||||
| OtherFirstName: | CORAZON | ||||||||
| OtherMiddleName: | CARDENO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 24730 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372024730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153862300 | ||||||||
| FaxNumber: | 6153862399 | ||||||||
| Practice Location | |||||||||
| Address1: | 4220 HARDING RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152226977 | ||||||||
| FaxNumber: | 6152225322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34085 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3857005 | 01 | MEDICARE | OTHER | H23857 | 01 | HEALTHSPRING | OTHER | 3857007 | 05 | TN | MEDICAID | P00365729 | 01 | RAILROAD MEDICARE | OTHER | P00395837 | 01 | RAILROAD MEDICARE | OTHER | 4137839 | 01 | TN | BLUE CROSS | OTHER | 7100007290 | 01 | KY | KENTUCKY MEDICAID | OTHER | 3857005 | 05 | TN | MEDICAID | 2102564 | 01 | FIRST HEALTH COVENTRY | OTHER | 4144468 | 01 | TN | BLUE CROSS | OTHER | 9682809 | 01 | CIGNA | OTHER | 7117354 | 01 | AETNA | OTHER |