Provider Demographics
NPI:1750087219
Name:BLANCA SALOME MALDONADO MARRIAGE AND FAMILY THERAPIST INC
Entity type:Organization
Organization Name:BLANCA SALOME MALDONADO MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-834-5383
Mailing Address - Street 1:78060 CALLE ESTADO STE 17
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2960
Mailing Address - Country:US
Mailing Address - Phone:760-834-5383
Mailing Address - Fax:
Practice Address - Street 1:78060 CALLE ESTADO STE 17
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2960
Practice Address - Country:US
Practice Address - Phone:760-834-5383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336639350OtherNPI