=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568516201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M&P CARE AT HOME CSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 01/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 CALLE MANUEL PAVIA STE 213
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-276-5355
-----------------------------------------------------
Fax | 787-722-2170
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6578 LOIZA STATE STATION
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00914-6578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-276-5355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENTE
-----------------------------------------------------
Name | NEIL MALDONADO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-276-5355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------