Provider Demographics
NPI:1134759715
Name:MALDONADO SANTIAGO, DAVID (IDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MALDONADO SANTIAGO
Suffix:
Gender:
Credentials:IDC
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IDC
Mailing Address - Street 1:1020 KAKALA ST APT 1306
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4547
Mailing Address - Country:US
Mailing Address - Phone:224-772-4927
Mailing Address - Fax:
Practice Address - Street 1:480 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman