Healthcare Provider Details

I. General information

NPI: 1770688541
Provider Name (Legal Business Name): DR. FELIX MALDONADO TRINIDAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2DA AVE 5 LOS ROSALES MANATI
MANATI PR
00674
US

IV. Provider business mailing address

2DA AVE LOS ROSALES
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-862-4124
  • Fax: 787-862-3532
Mailing address:
  • Phone: 787-862-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8431
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0011017
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerHUMANA GOBIERNO
# 2
Identifier29423
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE SSS, INC
# 3
Identifier999365
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERRED MEDICARE CHOISE
# 4
Identifier063206
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerCRUZ AZUL
# 5
IdentifierN231
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerINTERNATIONAL MEDICAL CAR
# 6
Identifier117552
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerACAA
# 7
Identifier2011510
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERRED HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: