Basic Information
| Provider Information | |||||||||
| NPI: | 1386742559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALDONADO | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | ENRIQUE | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 CALLE SAN JOSE | ||||||||
| Address2: | APT. 102 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879772430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2D-27 PINO ST. | ||||||||
| Address2: | VILLA DEL REY | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007256325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877435054 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 231H00000X | #2 | PR | X | Speech, Language and Hearing Service Providers | Audiologist | 231HA2400X | #2 | PR | X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | 231HA2500X | #2 | PR | X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | 237600000X | #2 | PR | X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.