Healthcare Provider Details

I. General information

NPI: 1790915650
Provider Name (Legal Business Name): GIL MALDONADO MANZANET DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALLE TOMAS DAVILA CDT-TMG MEDICAL GROUP C.S.P.
BARCELONETA PR
00617-2798
US

IV. Provider business mailing address

CALLE TOMAS DAVILA #1 CDT-TMG MEDICAL GROUP C.S.P.
BARCELONETA PR
00617
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number461
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: