Provider Demographics
NPI:1144006529
Name:MAISONET, EZEQUIEL (MS)
Entity type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:MAISONET
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:PO BOX 5000
Mailing Address - Street 2:SUITE 946
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-7003
Mailing Address - Country:US
Mailing Address - Phone:787-438-4823
Mailing Address - Fax:
Practice Address - Street 1:300 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3275
Practice Address - Country:US
Practice Address - Phone:787-669-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program