Healthcare Provider Details

I. General information

NPI: 1326103474
Provider Name (Legal Business Name): CHRISTINA MALDONADO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10602 CHAPMAN AVE STE 200
GARDEN GROVE CA
92840-3147
US

IV. Provider business mailing address

PO BOX 3102
MISSION VIEJO CA
92690-1102
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-0700
  • Fax:
Mailing address:
  • Phone: 949-722-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number58032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: