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General NPI Number Information
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NPI Number | 1710655915
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Entity Type | Individual
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Provider Name | EDUARDO JOSE MALDONADO
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Gender | Male
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 13835 GULLANE DR
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City | WOODBRIDGE
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State | VA
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Zip | 22191-1461
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Country | US
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Telephone | 703-678-9497
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Fax |
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Provider Business Mailing Address
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Address Line | 910 N IVERSON ST APT 302
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City | ALEXANDRIA
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State | VA
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Zip | 22304-6835
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Country | US
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Telephone | 954-793-3305
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-32126
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License Number State | FL
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