Provider Demographics
NPI:1588858054
Name:MALDONADO, MIRCA NOEMI (TO)
Entity Type:Individual
Prefix:MISS
First Name:MIRCA
Middle Name:NOEMI
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS LOMAS
Mailing Address - Street 2:CALLE 20 SO 1664
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-777-3535
Mailing Address - Fax:
Practice Address - Street 1:HOSP. PEDIATRICO UNIVERSITARIO, CENTRO PEDIATRICO METRO
Practice Address - Street 2:# 191079
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919-1079
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist