Provider Demographics
NPI:1528018058
Name:VALIENTE MALDONADO, GLORIA M (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:VALIENTE MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CALLE ROSA
Mailing Address - Street 2:COND CECILIA APT 714
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-7503
Mailing Address - Country:US
Mailing Address - Phone:787-370-5686
Mailing Address - Fax:
Practice Address - Street 1:HOME VISIT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-273-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021227Medicare ID - Type Unspecified
H81532Medicare UPIN