Provider Demographics
NPI:1508927484
Name:LEBRON-MALDONADO, CARMEN NILDA
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:NILDA
Last Name:LEBRON-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:PMB 173
Mailing Address - Street 2:PO BOX 7891
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-7891
Mailing Address - Country:US
Mailing Address - Phone:787-448-9696
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE TERAPIA FISICA ISLA VERDE
Practice Address - Street 2:LAGUNA GARDENS SUITE 211
Practice Address - City:ISLA VERDE
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:787-448-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine