Healthcare Provider Details

I. General information

NPI: 1194646000
Provider Name (Legal Business Name): SAMANTHA MALDONADO LCDA.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL CARR. #2, BLOQUE 51 #62, URB. SANTA ROSA
BAYAMON PR
00959
US

IV. Provider business mailing address

CA18 CALLE AREYTO
CAGUAS PR
00725-1458
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-2446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9068
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: