Provider Demographics
NPI:1902994445
Name:MALDONADO, MAYRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HACIENDA SAN JOSE
Mailing Address - Street 2:847 VIA PLACIDA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3075
Mailing Address - Country:US
Mailing Address - Phone:787-380-6011
Mailing Address - Fax:
Practice Address - Street 1:BO. QUEMADOS CARR 183 KM 10.4
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-380-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13495171100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH-55686Medicare UPIN
PR0083940Medicare ID - Type Unspecified