Provider Demographics
NPI:1851859896
Name:NIEVES MALDONADO, MICHELLE JANICE (PHYSICIAN RESIDENT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:JANICE
Last Name:NIEVES MALDONADO
Suffix:
Gender:F
Credentials:PHYSICIAN RESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 AVE. DE DIEGO GALLERY PLAZA
Mailing Address - Street 2:APT. 1606S
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911
Mailing Address - Country:US
Mailing Address - Phone:787-533-0966
Mailing Address - Fax:
Practice Address - Street 1:VA CARIBBEAN HEALTH SYSTEM
Practice Address - Street 2:10 CALLE CASIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR022676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program