Provider Demographics
NPI:1508838699
Name:MALDONADO, GERTRUDIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERTRUDIS
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 AVE HOSTOS
Mailing Address - Street 2:CONDOMINIO EL MONTE NORTE - APARTAMENTO 234
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4244
Mailing Address - Country:US
Mailing Address - Phone:787-281-0981
Mailing Address - Fax:
Practice Address - Street 1:315 CALLE RECINTO S
Practice Address - Street 2:OFICINA 2-B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1941
Practice Address - Country:US
Practice Address - Phone:787-724-4629
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical