Provider Demographics
NPI:1376321158
Name:JEFFREY MALDONADO MD LLC
Entity Type:Organization
Organization Name:JEFFREY MALDONADO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:MALDONADO PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-904-7292
Mailing Address - Street 1:2660 W 76TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5628
Mailing Address - Country:US
Mailing Address - Phone:787-904-7292
Mailing Address - Fax:
Practice Address - Street 1:2660 W 76TH ST APT 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5628
Practice Address - Country:US
Practice Address - Phone:787-904-7292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty