Provider Demographics
NPI:1801928171
Name:MALDONADO, ISRAEL JR (LMT)
Entity type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:
Last Name:MALDONADO
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2048
Mailing Address - Country:US
Mailing Address - Phone:440-339-5619
Mailing Address - Fax:
Practice Address - Street 1:6150 EMERALD ST
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2048
Practice Address - Country:US
Practice Address - Phone:440-339-5619
Practice Address - Fax:440-327-1656
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist