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General NPI Number Information
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NPI Number | 1164026787
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Entity Type | Individual
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Provider Name | ERIC ALEJANDRO MALDONADO LMFT
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Gender | Male
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1461 E COOLEY DR STE 100
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City | COLTON
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State | CA
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Zip | 92324-3921
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Country | US
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Telephone | 951-465-3664
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Fax |
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Provider Business Mailing Address
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Address Line | 17273 RUSSO CT
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City | FONTANA
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State | CA
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Zip | 92336-3237
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Country | US
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Telephone | 626-587-7669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT122401
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT155954
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License Number State | CA
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