Provider Demographics
NPI:1811272370
Name:MALDONADO, YENICA M I
Entity type:Individual
Prefix:MISS
First Name:YENICA
Middle Name:M
Last Name:MALDONADO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BO LOS LLANOS CALLE 3 #50 D
Mailing Address - Street 2:BOX 2283
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4283
Mailing Address - Country:US
Mailing Address - Phone:787-432-8308
Mailing Address - Fax:
Practice Address - Street 1:LOS LLANOS 50 D CALLE 3
Practice Address - Street 2:APARTADO 2283
Practice Address - City:COAMO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00769
Practice Address - Country:UM
Practice Address - Phone:787-432-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR170931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical