MEDICARE: DR. JORGE LUIS MALDONADO M.D.

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	174400000X	Specialist	K2359	TX
2	2084P0800X	Psychiatry Physician	K2359	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437192085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE LUIS MALDONADO M.D.

Provider Business Mailing Address
First Line	:	1634 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1929
Country	:	US
Telephone Number	:	210-541-8455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1634 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1929
Country	:	US
Telephone Number	:	210-541-8455
Fax Number	:

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/11/2024

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