Provider Demographics
NPI:1831160571
Name:MALDONADO, RAUL
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 W SESAME DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8364
Mailing Address - Country:US
Mailing Address - Phone:956-365-3334
Mailing Address - Fax:956-365-4656
Practice Address - Street 1:597 W SESAME DR
Practice Address - Street 2:SUITE G
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8364
Practice Address - Country:US
Practice Address - Phone:956-365-3334
Practice Address - Fax:956-365-4656
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018574601Medicaid
TX018574601Medicaid
U70537Medicare UPIN