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General NPI Number Information
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NPI Number | 1316581911
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Entity Type | Individual
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Provider Name | GISELLE MARIE MALDONADO LIC. OPTICO
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Gender | Female
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Dates
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Enumeration Date | 11/06/2019
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | BO CANAS CARR 10 KM 0.1
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City | PONCE
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State | PR
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Zip | 00728
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Country | US
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Telephone | 787-612-9301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 113
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City | PONCE
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State | PR
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Zip | 00715-0113
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Country | US
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Telephone | 787-612-9301
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 1358
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License Number State | PR
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