Provider Demographics
NPI:1487044400
Name:MALDONADO, MIGUEL JOVANY (LMP)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:JOVANY
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4779
Mailing Address - Country:US
Mailing Address - Phone:253-876-4900
Mailing Address - Fax:888-357-7244
Practice Address - Street 1:9003 CANYON DR
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4779
Practice Address - Country:US
Practice Address - Phone:253-876-4900
Practice Address - Fax:888-357-7244
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60412291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist