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1700368776 NPI number — JORGE ERNESTO MALDONADO JR.

NPI Number: 1700368776
Health Care Provider/Practitioner: JORGE ERNESTO MALDONADO JR.

Information about “1700368776” NPI (JORGE ERNESTO MALDONADO JR.) exists in 1700368776 in HTML format HTML  |  1700368776 in plain Text format TXT  |  1700368776 in PDF (Portable Document Format) PDF  |  1700368776 in an XML format XML  formats.

NPI Number : 1700368776 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700368776",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MALDONADO",
    "FirstName": "JORGE",
    "MiddleName": "ERNESTO",
    "NamePrefix": null,
    "NameSuffix": "JR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1800 H ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "UNION CITY",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94587-3321",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-471-2520",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1800 H ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "UNION CITY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94587-3321",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-471-2520",
    "PracticeLocationAddressFaxNumber": "510-487-8457",
    "EnumerationDate": "09/05/2018",
    "LastUpdateDate": "09/05/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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