MEDICARE: GRETCHEN LORRAINE MALDONADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	523-PA	PR

General Provider Information

NPI Number	:	1275362915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN LORRAINE MALDONADO

Provider Business Mailing Address
First Line	:	ESTANCIAS DEL REAL
Second Line	:	225 CALLE PRINCIPE
City	:	PONCE
State	:	PR
Zip	:	00780
Country	:	US
Telephone Number	:	787-428-6496
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 TORRE SAN CRISTOBAL
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00780-2826
Country	:	US
Telephone Number	:	787-841-9922
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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