Provider Demographics
NPI:1841656352
Name:MARTINEZ MALDONADO, PEDRO R (RN)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:R
Last Name:MARTINEZ MALDONADO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J3 CALLE E7A
Mailing Address - Street 2:URB. GLENVIEW GARDENS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-4325
Mailing Address - Country:US
Mailing Address - Phone:787-974-9867
Mailing Address - Fax:
Practice Address - Street 1:184 CALLE GUADALUPE PISO 2
Practice Address - Street 2:INSPIRA BEHAVIORAL CARE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-4325
Practice Address - Country:US
Practice Address - Phone:787-974-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35812163W00000X
PR2236163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health