Provider Demographics
NPI:1245505148
Name:MALDONADO, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MALDONADO
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 1:27 SUSAN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5242
Mailing Address - Country:US
Mailing Address - Phone:831-707-0799
Mailing Address - Fax:
Practice Address - Street 1:2716 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-1027
Practice Address - Country:US
Practice Address - Phone:831-688-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherSANTA CRUZ MEDICAL GROUP PTAN#