Provider Demographics
NPI:1518190347
Name:MALDONADO, MONIQUE BERNADETTE
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:BERNADETTE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:BERNADETTE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6951 S CAMINO DE LA TIERRA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-8273
Mailing Address - Country:US
Mailing Address - Phone:520-908-4216
Mailing Address - Fax:
Practice Address - Street 1:6951 S CAMINO DE LA TIERRA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-8273
Practice Address - Country:US
Practice Address - Phone:520-908-4216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 155954163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool