Provider Demographics
NPI:1740807221
Name:MALDONADO, RAYZA VICMARIE (PHD)
Entity Type:Individual
Prefix:
First Name:RAYZA
Middle Name:VICMARIE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:PHD
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 646
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0646
Mailing Address - Country:US
Mailing Address - Phone:939-332-0910
Mailing Address - Fax:
Practice Address - Street 1:81 CALLE 3 APT 512
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1684
Practice Address - Country:US
Practice Address - Phone:939-332-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical