Provider Demographics
NPI:1659601235
Name:MALDONADO, THRESA NOLESZENSKI (LMT)
Entity Type:Individual
Prefix:MRS
First Name:THRESA
Middle Name:NOLESZENSKI
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:THRESA
Other - Middle Name:NOLESZENSKI
Other - Last Name:CORONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3500 COMANCHE RD NE
Mailing Address - Street 2:SUITE E-22
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4546
Mailing Address - Country:US
Mailing Address - Phone:505-615-0597
Mailing Address - Fax:
Practice Address - Street 1:3500 COMANCHE RD NE
Practice Address - Street 2:SUITE E-22
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-615-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist