Healthcare Provider Details

I. General information

NPI: 1588500490
Provider Name (Legal Business Name): GABRIELA DE ANCA MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 678 URB SANTA RITA AA7
VEGA ALTA PR
00692
US

IV. Provider business mailing address

HC 33 BOX 4459
DORADO PR
00646-9727
US

V. Phone/Fax

Practice location:
  • Phone: 939-372-3775
  • Fax:
Mailing address:
  • Phone: 939-372-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1145
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: