Healthcare Provider Details

I. General information

NPI: 1750868204
Provider Name (Legal Business Name): MR. JAVIER MALDONADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 04/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEL RIO SHOPPING LOCAL A2-1
CAGUAS PR
00726
US

IV. Provider business mailing address

PO BOX 7589
CAGUAS PR
00726-7589
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-5353
  • Fax:
Mailing address:
  • Phone: 787-653-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number685
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: