Provider Demographics
NPI:1346226313
Name:MALDONADO MENDEZ, ADDISS (MD)
Entity Type:Individual
Prefix:
First Name:ADDISS
Middle Name:
Last Name:MALDONADO MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 10225
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9604
Mailing Address - Country:US
Mailing Address - Phone:787-914-3231
Mailing Address - Fax:
Practice Address - Street 1:CONSULTORIO MEDICO EL BUEN SAMARITANO CARRETERA 183
Practice Address - Street 2:CARRETERA 183 KM 10.7 BO. QUEMADOS
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9728207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7540015OtherHUMANA
PR82825OtherTRIPLE S
PR0082825Medicare ID - Type Unspecified
PRF47556Medicare UPIN