Provider Demographics
NPI:1831832229
Name:NIEVES MALDONADO, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:NIEVES MALDONADO
Suffix:
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 1:840 CALLE ANASCO
Mailing Address - Street 2:VILLAS DEL SOL APT 446
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-387-4760
Mailing Address - Fax:
Practice Address - Street 1:URB EXTENSION FOREST HILLS 419 #1
Practice Address - Street 2:CALLE LIMA EDIF ANGEL R COLLAZO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-636-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7215103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling