Healthcare Provider Details

I. General information

NPI: 1417951955
Provider Name (Legal Business Name): HECTOR IGNACIO MALDONADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. APOLO ESQ. ALEJANDRINO (ALTOS FCIA. LUIS)
GUAYNABO PR
00969
US

IV. Provider business mailing address

1214 AVE MAGDALENA COND. EL PLAZA APT. 6
SAN JUAN PR
00907-1713
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-8194
  • Fax: 787-720-8194
Mailing address:
  • Phone: 787-720-8194
  • Fax: 787-720-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7695
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: