Provider Demographics
NPI:1164691796
Name:MALDONADO, EDNA CARMEN (LND)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:CARMEN
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D66 CALLE 12
Mailing Address - Street 2:TOA ALTA HEIGHTS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4211
Mailing Address - Country:US
Mailing Address - Phone:787-479-7000
Mailing Address - Fax:
Practice Address - Street 1:LUIS MUNOZ MARIN- 155
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1229133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR535Medicare PIN