MEDICARE: LAURA DESIREE 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	208D00000X	General Practice Physician	25017	PR

General Provider Information

NPI Number	:	1396401931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DESIREE MALDONADO

Provider Business Mailing Address
First Line	:	STREET 177 COND LA CORUNA
Second Line	:	APT 602
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	787-590-2540
Fax Number	:

Provider Business Practice Location Address
First Line	:	STREET 177 COND LA CORUNA
Second Line	:	APT 602
City	:	GUAYNABO
State	:	PR
Zip	:	00969
Country	:	US
Telephone Number	:	787-590-2540
Fax Number	:

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

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	06/11/2026

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Directions to “ LAURA DESIREE MALDONADO ” Practice Location

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