Provider Demographics
NPI:1114344827
Name:MALDONADO MEDICAL, LLC
Entity Type:Organization
Organization Name:MALDONADO MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAXON MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-0077
Mailing Address - Street 1:1685 S. COLORADO BOULEVARD, UNIT S
Mailing Address - Street 2:SUITE 335
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222
Mailing Address - Country:US
Mailing Address - Phone:720-833-7706
Mailing Address - Fax:
Practice Address - Street 1:1685 S COLORADO BLVD UNIT S
Practice Address - Street 2:SUITE 335
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4011
Practice Address - Country:US
Practice Address - Phone:720-833-7706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies