Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 6458 | PR |
Y | 213ES0000X | Sports Medicine | 6458 | PR |
NPI | 1467440982 |
---|---|
Provider Name | Jesus Alberto Maldonado |
First Address | Guaynabo, PR 00968-3100 |
Second Address | Humacao, PR 00791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 17/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C79743 | (02) | PR |