Provider Demographics
NPI:1891980892
Name:MALDONADO-RIVERA, SANDRA N (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:N
Last Name:MALDONADO-RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO LOS CORALES II
Mailing Address - Street 2:738 MAR DE BENGAL
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4539
Mailing Address - Country:US
Mailing Address - Phone:787-614-8315
Mailing Address - Fax:
Practice Address - Street 1:PASEO LOS CORALES II
Practice Address - Street 2:738 MAR DE BENGAL
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4539
Practice Address - Country:US
Practice Address - Phone:787-614-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17989207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHG984AMedicare PIN