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General NPI Number Information
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NPI Number | 1194058800
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Entity Type | Organization
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Legal Business Name | CARLOS MALDONADO, D.O., P.A.
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Dates
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Enumeration Date | 09/13/2009
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Last Update Date | 09/13/2009
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Provider Practice Location Address
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Address Line | 2933 LAZY LAKE DR
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City | HARLINGEN
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State | TX
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Zip | 78550-8633
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Country | US
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Telephone | 956-276-0144
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Fax | 866-689-4246
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Provider Business Mailing Address
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Address Line | 2933 LAZY LAKE DR
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City | HARLINGEN
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State | TX
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Zip | 78550-8633
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Country | US
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Telephone | 956-276-0144
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Fax | 866-689-4246
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CARLOS MALDONADO
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Credential | D.O.
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Telephone | 956-276-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | J7064
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License Number State | TX
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