Provider Demographics
NPI:1518442516
Name:MALDONADO, IRIS NEREIDA
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:NEREIDA
Last Name: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 1:42 CALLE 3
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3422
Mailing Address - Country:US
Mailing Address - Phone:939-777-5900
Mailing Address - Fax:
Practice Address - Street 1:42 CALLE 3
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3422
Practice Address - Country:US
Practice Address - Phone:939-777-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
PR156FX1800X
1259156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty