Provider Demographics
NPI:1932125960
Name:MALDONADO, ALICIA M (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:MALDONADO
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:FRAY GRANADA 2026 EL SENORIAL
Mailing Address - Street 2:
Mailing Address - City:RIO PICDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-761-5366
Mailing Address - Fax:
Practice Address - Street 1:CORRETERA 172 ANEXO SAN JUAN BAUTISTA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:CAGNAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-704-7110
Practice Address - Fax:787-746-7377
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics