Provider Demographics
NPI:1023237393
Name:MALDONADO, MIGUEL
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:MALDONADO
Suffix:
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:PO BOX 6072
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00914-6072
Mailing Address - Country:US
Mailing Address - Phone:787-757-5420
Mailing Address - Fax:787-757-5430
Practice Address - Street 1:BOX 6072
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00914-6072
Practice Address - Country:US
Practice Address - Phone:787-757-5420
Practice Address - Fax:787-757-5430
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion