Provider Demographics
NPI:1790915650
Name:MALDONADO MANZANET, GIL (DC)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:
Last Name:MALDONADO MANZANET
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE TOMAS DAVILA #1
Mailing Address - Street 2:CDT-TMG MEDICAL GROUP C.S.P.
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617
Mailing Address - Country:US
Mailing Address - Phone:787-222-9263
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE TOMAS DAVILA
Practice Address - Street 2:CDT-TMG MEDICAL GROUP C.S.P.
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2798
Practice Address - Country:US
Practice Address - Phone:787-222-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR461111N00000X
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist