MEDICARE: IMELDA MALDONADO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	L22643401	AZ

General Provider Information

NPI Number	:	1255275582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMELDA MALDONADO

Provider Business Mailing Address
First Line	:	6061 W MILLAY ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-8260
Country	:	US
Telephone Number	:	520-273-7213
Fax Number	:

Provider Business Practice Location Address
First Line	:	6061 W MILLAY ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-8260
Country	:	US
Telephone Number	:	520-273-7213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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