Provider Demographics
NPI:1659688794
Name:MALDONADO-ROJAS, MARIS H (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARIS
Middle Name:H
Last Name:MALDONADO-ROJAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1619
Mailing Address - Country:US
Mailing Address - Phone:787-608-2959
Mailing Address - Fax:787-767-6743
Practice Address - Street 1:101 MB URB PARQUE DEL MONTE
Practice Address - Street 2:ENCANTADA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-608-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3777103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMHMR0714OtherMEDICARE AND OTHERS PLAN
PRMHMR0714OtherMEDICARE AND OTHERS PLAN