Provider Demographics
NPI:1356687420
Name:CAMARENO MALDONADO, MARIVETTE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIVETTE
Middle Name:
Last Name:CAMARENO MALDONADO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB MUNOZ RIVERA
Mailing Address - Street 2:45 CALLE TROPICAL
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-0000
Mailing Address - Country:US
Mailing Address - Phone:787-272-1390
Mailing Address - Fax:787-789-4874
Practice Address - Street 1:URB MUNOZ RIVERA
Practice Address - Street 2:45 CALLE TROPICAL
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0000
Practice Address - Country:US
Practice Address - Phone:787-272-1390
Practice Address - Fax:787-789-4874
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist