Provider Demographics
NPI:1982029005
Name:MALDONADO, IRMA
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 E CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3050
Mailing Address - Country:US
Mailing Address - Phone:323-374-6848
Mailing Address - Fax:323-374-6691
Practice Address - Street 1:1776 E CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3050
Practice Address - Country:US
Practice Address - Phone:323-374-6848
Practice Address - Fax:323-374-6691
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA840228163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse