Provider Demographics
NPI:1871746230
Name:CARDONA, ANSURIO JR (LSA)
Entity type:Individual
Prefix:
First Name:ANSURIO
Middle Name:
Last Name:CARDONA
Suffix:JR
Gender:M
Credentials:LSA
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Mailing Address - Street 1:11800 HORSESHOE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4892
Mailing Address - Country:US
Mailing Address - Phone:214-227-2457
Mailing Address - Fax:214-764-0880
Practice Address - Street 1:11800 HORSESHOE RIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4892
Practice Address - Country:US
Practice Address - Phone:214-208-6286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2024-08-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical