Provider Demographics
NPI:1912514753
Name:FELICIANO MALDONADO, AFORTUNADO
Entity Type:Individual
Prefix:
First Name:AFORTUNADO
Middle Name:
Last Name:FELICIANO 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:HC 3 BOX 5241
Mailing Address - Street 2:
Mailing Address - City:ADJUNTAS
Mailing Address - State:PR
Mailing Address - Zip Code:00601-9348
Mailing Address - Country:US
Mailing Address - Phone:787-470-9652
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE 4 DE JULIO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4498
Practice Address - Country:US
Practice Address - Phone:787-867-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22026208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice