Provider Demographics
NPI:1043757883
Name:MALDONADO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 N FALLS CIRCLE DR
Mailing Address - Street 2:APT 308
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6867
Mailing Address - Country:US
Mailing Address - Phone:754-245-2362
Mailing Address - Fax:
Practice Address - Street 1:6361 N FALLS CIRCLE DR
Practice Address - Street 2:APT 308
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-6867
Practice Address - Country:US
Practice Address - Phone:754-245-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other