1366435000 NPI number — MILCIADES MERCEDES MALDONADO MD

Table of content: MILCIADES MERCEDES MALDONADO MD (NPI 1366435000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366435000 NPI number — MILCIADES MERCEDES MALDONADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERCEDES MALDONADO
Provider First Name:
MILCIADES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1366435000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 JUAN B RODRIGUEZ
Provider Second Line Business Mailing Address:
MIRADOR DEL PARQUE 1101-2
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-360-0755
Provider Business Mailing Address Fax Number:
787-708-7788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 AVE LAS CUMBRES
Provider Second Line Business Practice Location Address:
STE 208B
Provider Business Practice Location Address City Name:
GUAYNABO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00969-5527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-360-8641
Provider Business Practice Location Address Fax Number:
787-708-7788
Provider Enumeration Date:
08/29/2005

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 16910 , 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)





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