Provider Demographics
NPI:1396741104
Name:MALDONADO, YASMIN S (MD)
Entity type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:S
Last Name:MALDONADO
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 1:120 UPTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7559
Mailing Address - Country:US
Mailing Address - Phone:956-982-0909
Mailing Address - Fax:956-982-0921
Practice Address - Street 1:120 UPTOWN AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7559
Practice Address - Country:US
Practice Address - Phone:956-982-0909
Practice Address - Fax:956-982-0921
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2023-02-03
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
TXK8793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029848102Medicaid
TX610923Medicare PIN
TXH10088Medicare UPIN