MEDICARE: MRS. LYDIA ESTHER MALDONADO ESQUILIN MD

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	208D00000X	General Practice Physician	10031	PR

General Provider Information

NPI Number	:	1275694713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA ESTHER MALDONADO ESQUILIN MD

Provider Business Mailing Address
First Line	:	E26 AVE RICKY SEDA
Second Line	:	URB IDA MARIS GARDENS
City	:	CAGUAS
State	:	PR
Zip	:	00727-5726
Country	:	US
Telephone Number	:	787-764-8018
Fax Number	:	787-763-5801

Provider Business Practice Location Address
First Line	:	WILLIAM JONES #1107 AHOS
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925
Country	:	US
Telephone Number	:	787-764-8018
Fax Number	:	787-763-5801

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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