Provider Demographics
NPI:1982197521
Name:MALDONADO-VITAL, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:MALDONADO-VITAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:940 STANTON L YOUNG BLVD
Mailing Address - Street 2:BMSB 451
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:KS
Mailing Address - Zip Code:73104
Mailing Address - Country:US
Mailing Address - Phone:405-271-2451
Mailing Address - Fax:
Practice Address - Street 1:940 STANTON L YOUNG BLVD
Practice Address - Street 2:BMSB 451
Practice Address - City:OKLAHOMA CITY
Practice Address - State:KS
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program