Provider Demographics
NPI:1396367108
Name:MALDONADO, GENESSIS CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:GENESSIS
Middle Name:CRISTINA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0011
Mailing Address - Country:US
Mailing Address - Phone:615-875-9593
Mailing Address - Fax:
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0011
Practice Address - Country:US
Practice Address - Phone:615-875-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2023-06-19
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-02-03
Provider Licenses
StateLicense IDTaxonomies
IL125076942207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine