Provider Demographics
NPI:1326008426
Name:DONATO, WALESKA M (DPM)
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:M
Last Name:DONATO
Suffix:
Gender:F
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:351 AVE HOSTOS STE 310
Mailing Address - Street 2:SUITE 310 MEDICAL EMPORIUM BUILDING
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1504
Mailing Address - Country:US
Mailing Address - Phone:787-806-1696
Mailing Address - Fax:787-833-6434
Practice Address - Street 1:351 HOSTOS AVE
Practice Address - Street 2:SUITE 310 MEDICAL EMPORIUM BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-806-1696
Practice Address - Fax:787-833-6434
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR0077213ES0131X
PR77213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0048079Medicare ID - Type Unspecified
U49838Medicare UPIN