Provider Demographics
NPI:1275533275
Name:MALDONADO VARGAS, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:MALDONADO VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:ANTONIO
Other - Last Name:MALDONADO VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 AVE LA SIERRA
Mailing Address - Street 2:APT. 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4330
Mailing Address - Country:US
Mailing Address - Phone:787-529-2964
Mailing Address - Fax:787-777-3855
Practice Address - Street 1:ADMINISTRACION DE SERVICIOS MEDICOS DE PR
Practice Address - Street 2:UPR-RADIOLOGIA, CARR. 22, BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:787-777-3855
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2018-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR145722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14572OtherPUERTO RICO MEDICINE ID
PRBM8006062OtherFEDERAL NARCOTICS
PRH95247Medicare UPIN