Provider Demographics
NPI:1992030084
Name:MALDONADO, ANGELICA ARIANA (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ARIANA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2168 S ATLANTIC BLVD
Mailing Address - Street 2:#302
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-6839
Mailing Address - Country:US
Mailing Address - Phone:951-764-4226
Mailing Address - Fax:
Practice Address - Street 1:3030 TYLER AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-3352
Practice Address - Country:US
Practice Address - Phone:626-350-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant