Provider Demographics
NPI:1417735861
Name:MALDONADO MARTY, GABRIELA ISABEL
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ISABEL
Last Name:MALDONADO MARTY
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:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-0561
Mailing Address - Country:US
Mailing Address - Phone:939-414-4551
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 3 KM. 8.3. AVE 65 DE INFANTERIA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-757-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program