Provider Demographics
NPI:1972765923
Name:MALDONADO, MARICARMEN (MT)
Entity Type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 VIA AVENTURA APT 7203
Mailing Address - Street 2:URB ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6190
Mailing Address - Country:US
Mailing Address - Phone:787-946-5653
Mailing Address - Fax:787-946-5653
Practice Address - Street 1:CARR 685 KM 2.9
Practice Address - Street 2:BO TIERRAS NUEVAS SALIENTE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-4676
Practice Address - Fax:787-884-4676
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1149291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory