Healthcare Provider Details

I. General information

NPI: 1407045859
Provider Name (Legal Business Name): MS. JESSICA PATRICIA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD SUITE 110
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

717 SAINT LOUIS AVE
LONG BEACH CA
90804-4558
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax: 562-865-5244
Mailing address:
  • Phone: 562-279-4655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: