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NPI Code Detail

MEDICARE: MS. MARYLOU MALDONADO RN, LMFT

MEDICARE: MS. MARYLOU MALDONADO RN, LMFT
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
1163W00000XRegistered Nurse671220CA
2106H00000XMarriage & Family Therapist53863CA

General Provider Information

NPI Number : 1861704827
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARYLOU MALDONADO RN, LMFT
Provider Business Mailing Address
First Line : 4004 BEYER BLVD
Second Line :
City : SAN DIEGO
State : CA
Zip : 92173-2007
Country : US
Telephone Number : 619-662-4100
Fax Number :
Provider Business Practice Location Address
First Line : 875 EL CAJON BLVD
Second Line :
City : EL CAJON
State : CA
Zip : 92020-5714
Country : US
Telephone Number : 619-662-4100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2010
Last Update Date : 07/17/2025

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