MEDICARE: PAULA IRMA MALDONADO NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	AP143926	TX
2	363LA2100X	Acute Care Nurse Practitioner	AP143926	TX
3	363LG0600X	Gerontology Nurse Practitioner	AP143926	TX
4	363LC0200X	Critical Care Medicine Nurse Practitioner	AP143926	TX

General Provider Information

NPI Number	:	1790325363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA IRMA MALDONADO NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR STE 119
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3711
Country	:	US
Telephone Number	:	210-575-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 119
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3711
Country	:	US
Telephone Number	:	210-575-9500
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	04/21/2022

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