MEDICARE: MR. ISRAEL MALDONADO JR. LMT

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	225700000X	Massage Therapist	9682	OH

General Provider Information

NPI Number	:	1801928171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISRAEL MALDONADO JR. LMT

Provider Business Mailing Address
First Line	:	6150 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2048
Country	:	US
Telephone Number	:	440-339-5619
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 EMERALD ST
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2048
Country	:	US
Telephone Number	:	440-339-5619
Fax Number	:	440-327-1656

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	02/21/2013

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