Healthcare Provider Details

I. General information

NPI: 1982457818
Provider Name (Legal Business Name): GABRIELA MATOS MALDONADO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONACILLOS CENTRO MEDICO DE PUERTO RICO
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

M35 CALLE 23
CAROLINA PR
00983-1635
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8152
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: