Provider Demographics
NPI:1376843904
Name:MALDONADO, TONY ARLYN (HAS)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:ARLYN
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NW 167TH PLACE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-924-7430
Mailing Address - Fax:503-924-7432
Practice Address - Street 1:1960 NW 167TH PLACE
Practice Address - Street 2:SUITE 203
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-924-7430
Practice Address - Fax:503-924-7432
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10131996237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist