Provider Demographics
NPI:1548592900
Name:MALDONADO CAMIS, EVELYN (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:MALDONADO CAMIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LAS HACIENDAS C/ CAMINO LARGO #35
Mailing Address - Street 2:15035
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9625
Mailing Address - Country:US
Mailing Address - Phone:787-550-8250
Mailing Address - Fax:
Practice Address - Street 1:URB. SAN ANTONIO
Practice Address - Street 2:A9 SUITE B
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-550-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRLISCENCEOther3477