Healthcare Provider Details

I. General information

NPI: 1487812533
Provider Name (Legal Business Name): LESLIE E MALDONADO PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA 116 B PSYCHOLOGY SERVICE
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

10 CASIA ST VA CARIBBEAN HEALTHCARE SYSTEM
SAN JUAN PR
00921-3201
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-5881
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2407
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1417
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: