Healthcare Provider Details

I. General information

NPI: 1962412304
Provider Name (Legal Business Name): ERNIE MALDONADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD PEDIATRICS DEPARTMENT
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE SUITE 201
ARCADIA CA
91006-7089
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-3082
  • Fax:
Mailing address:
  • Phone: 626-821-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: