Provider Demographics
NPI:1306556931
Name:MALDONADO, FLOR PATRICIA (LVN)
Entity type:Individual
Prefix:
First Name:FLOR
Middle Name:PATRICIA
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2720 EAST PALMDALE BLVD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550
Mailing Address - Country:US
Mailing Address - Phone:661-947-3333
Mailing Address - Fax:
Practice Address - Street 1:2720 E PALMDALE BLVD STE 129
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-947-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA683026164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA5211876Medicaid