Provider Demographics
NPI:1164174025
Name:MALDONADO, PATRICIA (CAREGIVER)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 W SUNSHADE CV
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-6718
Mailing Address - Country:US
Mailing Address - Phone:801-502-0247
Mailing Address - Fax:
Practice Address - Street 1:5527 W SUNSHADE CV
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-6718
Practice Address - Country:US
Practice Address - Phone:801-502-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174200000X, 251G00000X, 372600000X, 3747A0650X, 3747P1801X, 376J00000X, 385H00000X, 372500000X
UT73203393102163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No174200000XOther Service ProvidersMeals
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No251G00000XAgenciesHospice Care, Community Based
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care