Provider Demographics
NPI:1669065009
Name:ROSA MALDONADO, ANGELIVETTE (PSYD GRADUATE STUDEN)
Entity type:Individual
Prefix:MISS
First Name:ANGELIVETTE
Middle Name:
Last Name:ROSA MALDONADO
Suffix:
Gender:F
Credentials:PSYD GRADUATE STUDEN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 AVE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4527
Mailing Address - Country:US
Mailing Address - Phone:787-641-9133
Mailing Address - Fax:
Practice Address - Street 1:108 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4527
Practice Address - Country:US
Practice Address - Phone:787-641-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program