Healthcare Provider Details

I. General information

NPI: 1235533365
Provider Name (Legal Business Name): DR. GIL MALDONADO MANZANET, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C67 CALLE GEORGETTI URB CATALANA
BARCELONETA PR
00617
US

IV. Provider business mailing address

335 CALLE ISLA VERDE URB VILLAS DE LA PLAYA
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-623-2526
  • Fax:
Mailing address:
  • Phone: 787-222-9263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. GIL MALDONADO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 787-623-2526