Provider Demographics
NPI:1265574677
Name:MALDONADO RODRIGUEZ, MARISOL (MD)
Entity type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:MALDONADO RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
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 1752
Mailing Address - Street 2:CALLE LOPE HORMOZABAL #40 URB. MADRID
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1752
Mailing Address - Country:US
Mailing Address - Phone:787-734-6020
Mailing Address - Fax:787-734-0006
Practice Address - Street 1:40 CALLE LOPEZ HORMAZABAL
Practice Address - Street 2:CALLE LOPE HORMOZABAL #40
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3105
Practice Address - Country:US
Practice Address - Phone:787-734-6020
Practice Address - Fax:787-734-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13081174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMMMOther998709
PRPREFERRED HEALTH PLAOther209515
PRIMCOther7843
PRTRIPLE SOther20997
PRHUMANA REFORMAOther7920027
PRPALICOtherPE4466
PRAMERICANHEALTHPLANOther1196
PRGLOBAL HEATLHOther12613081
PRAMERICANHEALTHPLANOther1196
PRMEDICAREMedicare ID - Type Unspecified20997