Provider Demographics
NPI:1194019851
Name:MALDONADO, VILMA I
Entity Type:Individual
Prefix:MRS
First Name:VILMA
Middle Name:I
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3141
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9407
Mailing Address - Country:US
Mailing Address - Phone:787-859-5439
Mailing Address - Fax:787-859-5885
Practice Address - Street 1:HC 1 BOX 3141
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-9407
Practice Address - Country:US
Practice Address - Phone:787-859-5439
Practice Address - Fax:787-859-5885
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist