Healthcare Provider Details

I. General information

NPI: 1295436319
Provider Name (Legal Business Name): JOSE JULIAN MALDONADO MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARRIO MONACILLOS SAN JUAN PR
SAN JUAN PR
00935-0001
US

IV. Provider business mailing address

D79 CALLE ALCAZAR
BAYAMON PR
00961-7313
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-0101
  • Fax:
Mailing address:
  • Phone: 787-371-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17612-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: