Provider Demographics
NPI:1790864874
Name:MALDONADO, ELIZABETH (MS-A)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 393200
Mailing Address - Street 2:AVE R. CORDERO 140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-469-3710
Mailing Address - Fax:
Practice Address - Street 1:PD PLAZA LOCAL 6
Practice Address - Street 2:AVE. JOSE MERCADO 112
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-469-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR257231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR257OtherSTATE LICENSE
PR257OtherSTATE LICENSE