Provider Demographics
NPI:1053659003
Name:MALDONADO, MARIA J (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13412 SW 62ND ST APT M112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1294
Mailing Address - Country:US
Mailing Address - Phone:305-546-5638
Mailing Address - Fax:
Practice Address - Street 1:13412 SW 62ND ST
Practice Address - Street 2:M-112
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5052
Practice Address - Country:US
Practice Address - Phone:305-546-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 39411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist