Provider Demographics
NPI:1396215380
Name:MALDONADO, JEANETTE ALEXIS (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:ALEXIS
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 FALDO DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8113
Mailing Address - Country:US
Mailing Address - Phone:956-236-9281
Mailing Address - Fax:
Practice Address - Street 1:141 RVG PKWY STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5289
Practice Address - Country:US
Practice Address - Phone:972-685-4035
Practice Address - Fax:214-594-0840
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12551207N00000X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical