Healthcare Provider Details

I. General information

NPI: 1730663261
Provider Name (Legal Business Name): KATIA MORENO MALDONADO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL B5
CAGUAS PR
00726-9809
US

IV. Provider business mailing address

W22 CALLE LEALTAD 4TA SECCION LEVITTOWN
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax: 787-744-7444
Mailing address:
  • Phone: 787-704-0705
  • Fax: 787-744-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26176
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: