Provider Demographics
NPI:1154438158
Name:VERGNE MALDONADO, JULIO E (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:E
Last Name:VERGNE MALDONADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 193044
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3044
Mailing Address - Country:US
Mailing Address - Phone:787-945-1472
Mailing Address - Fax:787-250-9265
Practice Address - Street 1:CAROLINA SHOPPING COURT, SUITE 201 A
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-767-8758
Practice Address - Fax:844-759-2966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR015422208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38124000Medicaid