Provider Demographics
NPI:1619023462
Name:MALDONADO, PURA (MD)
Entity Type:Individual
Prefix:DR
First Name:PURA
Middle Name:
Last Name: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:ALTURAS DE PENUELAS II CALLE 16 Q 25
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-3609
Mailing Address - Country:US
Mailing Address - Phone:787-636-3953
Mailing Address - Fax:
Practice Address - Street 1:CARR149 KM 58.2
Practice Address - Street 2:BARRIO TIERRA SANTA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-4667
Practice Address - Fax:787-847-6757
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9770OtherPROFESIONAL LICENSE