Provider Demographics
NPI:1134582026
Name:AMARO MALDONADO, JIMMY SR (REGISTER NURSE)
Entity type:Individual
Prefix:MRS
First Name:JIMMY
Middle Name:
Last Name:AMARO MALDONADO
Suffix:SR
Gender:M
Credentials:REGISTER NURSE
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 843
Mailing Address - Street 2:
Mailing Address - City:MAUNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00707-0843
Mailing Address - Country:US
Mailing Address - Phone:787-615-2081
Mailing Address - Fax:787-866-3322
Practice Address - Street 1:CALLE 2 CARR 750
Practice Address - Street 2:URB LOS ALMENDROS PARCELA D10
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707-0843
Practice Address - Country:US
Practice Address - Phone:787-615-2081
Practice Address - Fax:787-866-3322
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR78389163W00000X, 163WA2000X, 163WG0000X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR78389OtherLICENSE REGISTER NURSE GENERALIST
PR6218693OtherLICENCIES