Provider Demographics
NPI:1407045859
Name:MALDONADO, JESSICA PATRICIA
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:PATRICIA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SAINT LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-4558
Mailing Address - Country:US
Mailing Address - Phone:562-279-4655
Mailing Address - Fax:
Practice Address - Street 1:21520 PIONEER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2603
Practice Address - Country:US
Practice Address - Phone:562-865-3644
Practice Address - Fax:562-865-5244
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health