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General NPI Number Information
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NPI Number | 1336268713
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Entity Type | Individual
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Provider Name | MARIO DAVID MALDONADO TBS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 921 W AVENUE J
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City | LANCASTER
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State | CA
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Zip | 93534-3443
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Country | US
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Telephone | 661-949-0131
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Fax | 661-729-8912
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Provider Business Mailing Address
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Address Line | 3300 15TH ST W SPC 76
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City | ROSAMOND
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State | CA
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Zip | 93560-7316
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Country | US
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Telephone | 661-256-8108
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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