Healthcare Provider Details

I. General information

NPI: 1285757203
Provider Name (Legal Business Name): MRS. MARGARITA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 5 BOX 8537
BAYAMON PR
00956-9757
US

IV. Provider business mailing address

URB ESTANCIAS DE CERRO GORDO K3 CALLE 9
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-797-5065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number4472
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: