Provider Demographics
NPI:1366002578
Name:MALDONADO PREMIUM HEALTH LLC
Entity Type:Organization
Organization Name:MALDONADO PREMIUM HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:FERDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-440-0283
Mailing Address - Street 1:HC 2 BOX 7726
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9091
Mailing Address - Country:US
Mailing Address - Phone:939-440-0283
Mailing Address - Fax:787-915-7848
Practice Address - Street 1:102 CALLE ARIZMENDI
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-2048
Practice Address - Country:US
Practice Address - Phone:939-440-0283
Practice Address - Fax:787-915-7848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty