Provider Demographics
NPI:1396135489
Name:MALDONADO, MARTA EVANGELINA (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:EVANGELINA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:BSN, RN
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 1719
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1719
Mailing Address - Country:US
Mailing Address - Phone:787-641-0773
Mailing Address - Fax:
Practice Address - Street 1:996 SAN ROBERTO ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17420251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health