Provider Demographics
NPI:1275362915
Name:MALDONADO, GRETCHEN LORRAINE
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LORRAINE
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DEL REAL
Mailing Address - Street 2:225 CALLE PRINCIPE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-428-6496
Mailing Address - Fax:
Practice Address - Street 1:101 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780-2826
Practice Address - Country:US
Practice Address - Phone:787-841-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR523-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical