Provider Demographics
NPI:1467440982
Name:MALDONADO, JESUS ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALBERTO
Last Name:MALDONADO
Suffix:
Gender:M
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:I7 CALLE EBANO
Mailing Address - Street 2:APT. 1203
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3100
Mailing Address - Country:US
Mailing Address - Phone:787-793-0722
Mailing Address - Fax:
Practice Address - Street 1:AVE. FONT MARTELO #3
Practice Address - Street 2:HIMA HOSPITAL HUMACAO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-656-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR64582081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79743Medicare UPIN