MEDICARE: CARLOS MALDONADO D.O.,P.A.

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	2085R0202X	Diagnostic Radiology Physician	J7064	TX

General Provider Information

NPI Number	:	1699147082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS MALDONADO D.O.,P.A.

Provider Business Mailing Address
First Line	:	2933 LAZY LAKE DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-8633
Country	:	US
Telephone Number	:	956-421-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 VICTORIA LN
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78550-3225
Country	:	US
Telephone Number	:	956-425-9600
Fax Number	:	956-581-0313

Authorized Official
Title or Position	:	CEO
Name	:	DR. CARLOS MALDONADO
Credential	:	D.O.
Telephone Number	:	956-421-3383

Provider Enumeration Date	:	10/23/2015
Last Update Date	:	10/23/2015

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