Provider Demographics
NPI:1396937744
Name:MALDONADO, FEDERICO GERARDO (PA)
Entity type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:GERARDO
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2233
Mailing Address - Country:US
Mailing Address - Phone:562-690-8082
Mailing Address - Fax:
Practice Address - Street 1:15022 MULBERRY DR.
Practice Address - Street 2:
Practice Address - City:LAMIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638
Practice Address - Country:US
Practice Address - Phone:562-946-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10014364SX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0106XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOccupational Health