Healthcare Provider Details

I. General information

NPI: 1871512764
Provider Name (Legal Business Name): JUAN JOSE HERNANDEZ-MALDONADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON SUITE 210 TORRE MEDICA AUXILIO MUTUO
SAN JUAN PR
00917-5024
US

IV. Provider business mailing address

735 AVE PONCE DE LEON SUITE 210 TORRE MEDICA AUXILIO MUTUO
SAN JUAN PR
00917-5024
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-0417
  • Fax: 787-773-0419
Mailing address:
  • Phone: 787-773-0417
  • Fax: 787-773-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number8880
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: