Provider Demographics
NPI:1972487478
Name:LISBOA CARDONA, JOMAR J
Entity type:Individual
Prefix:
First Name:JOMAR
Middle Name:J
Last Name:LISBOA CARDONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 9033
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-6746
Mailing Address - Country:US
Mailing Address - Phone:939-251-9430
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 9033
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-6746
Practice Address - Country:US
Practice Address - Phone:939-251-9430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical