Healthcare Provider Details

I. General information

NPI: 1619598984
Provider Name (Legal Business Name): DIANA DOLORES CARDENAS MALDONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MILITARY HEIGHTS PL
ROSWELL NM
88201-6407
US

IV. Provider business mailing address

PO BOX 1574
ROSWELL NM
88202-1574
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-9500
  • Fax: 575-627-9535
Mailing address:
  • Phone: 575-627-9500
  • Fax: 575-627-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD2025-0090
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: