Healthcare Provider Details

I. General information

NPI: 1275694713
Provider Name (Legal Business Name): LYDIA ESTHER MALDONADO ESQUILIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILLIAM JONES #1107 AHOS
RIO PIEDRAS PR
00925
US

IV. Provider business mailing address

E26 AVE RICKY SEDA URB IDA MARIS GARDENS
CAGUAS PR
00727-5726
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8018
  • Fax: 787-763-5801
Mailing address:
  • Phone: 787-764-8018
  • Fax: 787-763-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10031
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: