1477338754 NPI number — MARIA DE LOS ANGELES PUENTE MALDONADO DOULA

Table of content: MARIA DE LOS ANGELES PUENTE MALDONADO DOULA (NPI 1477338754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477338754 NPI number — MARIA DE LOS ANGELES PUENTE MALDONADO DOULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PUENTE MALDONADO
Provider First Name:
MARIA
Provider Middle Name:
DE LOS ANGELES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DOULA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
MARIA
Provider Other Middle Name:
DE LOS ANGELES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DOULA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477338754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1815 NE 148TH CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-7802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 NE 148TH CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-7802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-332-7103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2023

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: 374J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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