Provider Demographics
NPI:1598404394
Name:MALDONADO, KARLA MICHELLE
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
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:HACIENDA LA MATILDE
Mailing Address - Street 2:CALLE TRAPICHE 5178
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-412-3220
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA LA MATILDE
Practice Address - Street 2:CALLE TRAPICHE 5178
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-412-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician