Basic Information
| Provider Information | |||||||||
| NPI: | 1295821833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALDONADO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20577 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933900577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614779283 | ||||||||
| FaxNumber: | 6613268022 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 OLD RIVER RD | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933119781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614779283 | ||||||||
| FaxNumber: | 6613268022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | A94678 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A946780 | 01 | CA | MEDI-CAL | OTHER |