Provider Demographics
NPI:1629358080
Name:MALDONADO, LUIS (RN)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 EXT VISTAS DE CAMUY
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2945
Mailing Address - Country:US
Mailing Address - Phone:787-356-4815
Mailing Address - Fax:
Practice Address - Street 1:CARR # 3 KM 8.4
Practice Address - Street 2:PASEO DEL PRADO SHOPPING CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-750-2830
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30183163WN0300X
FLRN 9268306163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology