Provider Demographics
NPI:1720099278
Name:MALDONADO, JUAN MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MARIO
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 193946
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3946
Mailing Address - Country:US
Mailing Address - Phone:787-751-6701
Mailing Address - Fax:787-751-8637
Practice Address - Street 1:735 AVENIDA PONCE DE LEON
Practice Address - Street 2:TORRE DEL AUXILIO MUTUO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-751-6701
Practice Address - Fax:787-763-6259
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-05-14
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Provider Licenses
StateLicense IDTaxonomies
PR13170208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery