Provider Demographics
NPI:1215651831
Name:MALDONADO, ADRIAN LEE
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:LEE
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 MEADOW ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3730
Mailing Address - Country:US
Mailing Address - Phone:956-773-8161
Mailing Address - Fax:
Practice Address - Street 1:648 MEADOW ARBOR LN
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3730
Practice Address - Country:US
Practice Address - Phone:956-773-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84928101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health