Provider Demographics
NPI:1932563723
Name:MALDONADO-COLON, EDUARDO J
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:J
Last Name:MALDONADO-COLON
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 1:81 CARRETERA 20, APT 2
Mailing Address - Street 2:VILLAS DE TIVOLI
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-0001
Mailing Address - Country:US
Mailing Address - Phone:787-438-9157
Mailing Address - Fax:
Practice Address - Street 1:126 AVE DE DIEGO, STE 2
Practice Address - Street 2:SEIN MEDICAL PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0001
Practice Address - Country:US
Practice Address - Phone:787-208-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151503208100000X
390200000X
PR021902208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110837500Medicaid