Healthcare Provider Details

I. General information

NPI: 1396401931
Provider Name (Legal Business Name): LAURA DESIREE MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 177 COND LA CORUNA APT 602
GUAYNABO PR
00969
US

IV. Provider business mailing address

STREET 177 COND LA CORUNA APT 602
GUAYNABO PR
00969
US

V. Phone/Fax

Practice location:
  • Phone: 787-590-2540
  • Fax:
Mailing address:
  • Phone: 787-590-2540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25017
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: