Provider Demographics
NPI:1023597358
Name:MALDONADO CAQUIAS, ABIGAIL D
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:D
Last Name:MALDONADO CAQUIAS
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 1:1503 CALLE PROF. AUGUSTO RODRIGUEZ
Mailing Address - Street 2:CONDOMINIO ASIA, SUITE 600
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-497-0800
Mailing Address - Fax:787-982-6464
Practice Address - Street 1:1503 CALLE PROF. AUGUSTO RODRIGUEZ
Practice Address - Street 2:CONDOMINIO ASIA, SUITE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:787-982-6464
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$Medicaid