MEDICARE: DR. MILLISSETTE D MALDONADO 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	17974	PR

General Provider Information

NPI Number	:	1568776359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILLISSETTE D MALDONADO MD

Provider Business Mailing Address
First Line	:	519 CALLE EDDIE GRACIA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-2649
Country	:	US
Telephone Number	:	787-974-0563
Fax Number	:

Provider Business Practice Location Address
First Line	:	CONDOMINIO EL CENTRO 2
Second Line	:	AVE MUNOZ RIVERA APARTAMENTO 1401
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3300
Country	:	US
Telephone Number	:	787-974-0563
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	05/08/2017

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