1114810165 NPI number — CAROLINA MALDONADO C ORREA

Table of content: DAWN CAPRI DINEYAZHE PT (NPI 1578531968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114810165 NPI number — CAROLINA MALDONADO C ORREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO C ORREA
Provider First Name:
CAROLINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MALDONADO
Provider Other First Name:
CAROLINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CAROLINA MALDONADO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114810165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 BRUSH ST APT 909
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48226-4331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-923-1400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2950 CLEVELAND CLINIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-659-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PY12750 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)