Provider Demographics
NPI:1063842268
Name:MALDONADO, MYNOR JR
Entity Type:Individual
Prefix:
First Name:MYNOR
Middle Name:
Last Name:MALDONADO
Suffix:JR
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 1:3480 BUSKIRK AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4341
Mailing Address - Country:US
Mailing Address - Phone:925-933-2627
Mailing Address - Fax:
Practice Address - Street 1:3480 BUSKIRK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4341
Practice Address - Country:US
Practice Address - Phone:925-933-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health