Provider Demographics
NPI:1013809912
Name:MIRANDA MALDONADO, JONATHAN ANDRES (MS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDRES
Last Name:MIRANDA MALDONADO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BOSQUE DEL LAGO-ENCANTADA
Mailing Address - Street 2:BF-17, CALLE PLAZA #14
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-451-7041
Mailing Address - Fax:
Practice Address - Street 1:EXPLORA CENTRO ACADEMICO Y TERAPEUTICO
Practice Address - Street 2:CALLE CARAZO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5717
Practice Address - Country:US
Practice Address - Phone:787-710-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist