Healthcare Provider Details

I. General information

NPI: 1467440982
Provider Name (Legal Business Name): JESUS ALBERTO MALDONADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. FONT MARTELO #3 HIMA HOSPITAL HUMACAO
HUMACAO PR
00791
US

IV. Provider business mailing address

I7 CALLE EBANO APT. 1203
GUAYNABO PR
00968-3100
US

V. Phone/Fax

Practice location:
  • Phone: 787-656-2424
  • Fax:
Mailing address:
  • Phone: 787-793-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number6458
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: