Provider Demographics
NPI:1891479176
Name:CORREA DE MALDONADO, MARIA JUANA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JUANA
Last Name:CORREA DE MALDONADO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25772 DELPHINIUM AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5069
Mailing Address - Country:US
Mailing Address - Phone:805-368-8435
Mailing Address - Fax:
Practice Address - Street 1:25772 DELPHINIUM AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5069
Practice Address - Country:US
Practice Address - Phone:805-368-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily