Provider Demographics
NPI:1740617752
Name:MALDONADO, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 BUSINESS PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-8985
Mailing Address - Country:US
Mailing Address - Phone:775-392-2657
Mailing Address - Fax:775-392-2455
Practice Address - Street 1:2560 BUSINESS PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-8985
Practice Address - Country:US
Practice Address - Phone:775-392-2657
Practice Address - Fax:775-392-2455
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner