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General NPI Number Information
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NPI Number | 1508085499
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Entity Type | Organization
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Legal Business Name | NELSON R. MALDONADOM.D.,INC.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 150 CATHERINE LN SUITE G
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5719
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Country | US
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Telephone | 530-477-0931
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Fax | 530-477-0934
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Provider Business Mailing Address
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Address Line | PO BOX 2618
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City | GRASS VALLEY
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State | CA
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Zip | 95945-2618
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Country | US
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Telephone | 530-477-0931
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Fax | 530-477-0934
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELSON R. MALDONADO
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Credential | M.D.
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Telephone | 530-477-0931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 208600000X
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License Number State | CA
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