1144742560 NPI number — MRS. LADY JUDITH MALDONADO M.A.

Table of content: MRS. LADY JUDITH MALDONADO M.A. (NPI 1144742560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144742560 NPI number — MRS. LADY JUDITH MALDONADO M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO
Provider First Name:
LADY
Provider Middle Name:
JUDITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1144742560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00732-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-638-3788
Provider Business Mailing Address Fax Number:
787-984-2019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SANTA MARIA MEDICAL BUILDING CALLE FERROCAMLL 450
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-984-2019
Provider Business Practice Location Address Fax Number:
787-984-2019
Provider Enumeration Date:
07/07/2017

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: 103TC1900X , with the licence number:  5481 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 5481 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com