Provider Demographics
NPI:1992372551
Name:MALDONADO, ROLANDO III
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:MALDONADO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79844 BETHPAGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0922
Mailing Address - Country:US
Mailing Address - Phone:760-620-3213
Mailing Address - Fax:
Practice Address - Street 1:79844 BETHPAGE AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-0922
Practice Address - Country:US
Practice Address - Phone:760-620-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)