Basic Information
| Provider Information | |||||||||
| NPI: | 1871049536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALDONADO RIVERA | ||||||||
| FirstName: | HIRAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70344 | ||||||||
| Address2: | SAN JUAN CITY HOSPITAL PMB 498 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874802700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTRO MEDICO PUERTO RICO | ||||||||
| Address2: | BO. MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874802700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2016 | ||||||||
| LastUpdateDate: | 08/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PR | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.