Provider Demographics
NPI:1457568826
Name:RIVERA MALDONADO, JOSE ANGEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:RIVERA MALDONADO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CALLE CEDRO
Mailing Address - Street 2:URB. MONTECASINO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3733
Mailing Address - Country:US
Mailing Address - Phone:787-238-7792
Mailing Address - Fax:
Practice Address - Street 1:134 CALLE CEDRO
Practice Address - Street 2:URB. MONTECASINO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3733
Practice Address - Country:US
Practice Address - Phone:787-238-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical