Provider Demographics
NPI:1285106286
Name:MALDONADO ESCOBAR, XIOMARA (MD)
Entity type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:MALDONADO ESCOBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:PUNTA SANTIAGO
Mailing Address - State:PR
Mailing Address - Zip Code:00741-0643
Mailing Address - Country:US
Mailing Address - Phone:787-628-5956
Mailing Address - Fax:
Practice Address - Street 1:461 CALLE PICUA PARCELAS VIEJAS
Practice Address - Street 2:
Practice Address - City:PUNTA SANTIAGO
Practice Address - State:PR
Practice Address - Zip Code:00741
Practice Address - Country:US
Practice Address - Phone:787-628-5956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21190208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice