Provider Demographics
NPI:1003393711
Name:MALDONADO,, DIANA MARGARITA (LVN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARGARITA
Last Name:MALDONADO,
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 REY DAVID DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4418
Mailing Address - Country:US
Mailing Address - Phone:956-639-0732
Mailing Address - Fax:
Practice Address - Street 1:3569 REY DAVID DR
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4418
Practice Address - Country:US
Practice Address - Phone:956-639-0732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309379164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1790847531Medicaid