Healthcare Provider Details

I. General information

NPI: 1912088451
Provider Name (Legal Business Name): KARLA MICHELLE MALDONADO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AVE SAN PATRICIO STE 830 MARAMAR PLAZA
GUAYNABO PR
00968-2679
US

IV. Provider business mailing address

#1 AVE. PALMA REAL APT. 1411 MURANO LUXURY APARTMENTS
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-918-2737
  • Fax: 787-783-7320
Mailing address:
  • Phone: 787-946-4953
  • Fax: 787-783-7320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2697
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: