Provider Demographics
NPI:1700851458
Name:MALDONADO, MIRIAM MERCEDES (LM)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MERCEDES
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33255-7203
Mailing Address - Country:US
Mailing Address - Phone:786-234-9056
Mailing Address - Fax:813-365-3074
Practice Address - Street 1:10570 NW 27TH ST STE H102B
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2104
Practice Address - Country:US
Practice Address - Phone:786-607-2229
Practice Address - Fax:813-365-3074
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FLMW165176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014406800Medicaid
FL340536200Medicaid