Provider Demographics
NPI:1639936404
Name:MALDONADO, LUIS GERARDO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GERARDO
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 BRANDON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-2346
Mailing Address - Country:US
Mailing Address - Phone:915-234-8980
Mailing Address - Fax:
Practice Address - Street 1:11820 CYPRESS CORNER LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-1132
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician