Basic Information
| Provider Information | |||||||||
| NPI: | 1346973369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARDOSO CHAVEZ | ||||||||
| FirstName: | PETRA | ||||||||
| MiddleName: | GRICEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5860 RANCH LAKE BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD RANCH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342023719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412292122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5860 RANCH LAKE BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342023719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412292122 | ||||||||
| FaxNumber: | 9417573732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2022 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | AY2600 | FL | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | 231H00000X | AY2600 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.