Healthcare Provider Details

I. General information

NPI: 1619023462
Provider Name (Legal Business Name): PURA MALDONADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR149 KM 58.2 BARRIO TIERRA SANTA
VILLALBA PR
00766
US

IV. Provider business mailing address

ALTURAS DE PENUELAS II CALLE 16 Q 25
PENUELAS PR
00624-3609
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-4667
  • Fax: 787-847-6757
Mailing address:
  • Phone: 787-636-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9770
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: