Healthcare Provider Details

I. General information

NPI: 1851789812
Provider Name (Legal Business Name): BEATRIZ MALDONADO OTL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE / CEDRO #418 VISTAS DE RIO GRANDE II
RIO GRANDE PR
00745
US

IV. Provider business mailing address

VISTAS DE RIO GRANDE I I CALLE/ CEDRO #418
RIO GRANDE PUERTO RICO
00745
UM

V. Phone/Fax

Practice location:
  • Phone: 787-949-7592
  • Fax:
Mailing address:
  • Phone: 787-949-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number754
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: