Provider Demographics
NPI:1144540816
Name:MALDONADO MEDICAL, LLC
Entity type:Organization
Organization Name:MALDONADO MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAXON MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-265-0077
Mailing Address - Street 1:19820 N 7TH AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4736
Mailing Address - Country:US
Mailing Address - Phone:602-265-0077
Mailing Address - Fax:602-265-1551
Practice Address - Street 1:2022 BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2971
Practice Address - Country:US
Practice Address - Phone:310-622-4838
Practice Address - Fax:310-622-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5740720002Medicare NSC