Provider Demographics
NPI:1912929308
Name:MALDONADO, VICTOR KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:KEVIN
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:146 CALLE VASALLO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1926
Mailing Address - Country:US
Mailing Address - Phone:787-667-3108
Mailing Address - Fax:
Practice Address - Street 1:274 CALLE CONVENTO
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-725-5143
Practice Address - Fax:787-977-8424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15310207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH-66270Medicare UPIN
PR002-2589Medicare ID - Type Unspecified