1215031406 NPI number — DR. LORETTO JOAN MALDONADO PHD

Table of content: DR. LORETTO JOAN MALDONADO PHD (NPI 1215031406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215031406 NPI number — DR. LORETTO JOAN MALDONADO PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO
Provider First Name:
LORETTO
Provider Middle Name:
JOAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1215031406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
398 CAMINO GARDENS BLVD
Provider Second Line Business Mailing Address:
STE 207
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-367-9997
Provider Business Mailing Address Fax Number:
561-391-3574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
398 CAMINO GARDENS BLVD
Provider Second Line Business Practice Location Address:
STE 207
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-367-9997
Provider Business Practice Location Address Fax Number:
561-391-3574
Provider Enumeration Date:
09/11/2006

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: 103TC0700X , with the licence number:  PY0003787 , 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)





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