Provider Demographics
NPI:1386742559
Name:MALDONADO, MIGUEL ENRIQUE (AUD)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ENRIQUE
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CALLE SAN JOSE
Mailing Address - Street 2:APT. 102
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:787-977-2430
Mailing Address - Fax:
Practice Address - Street 1:2D-27 PINO ST.
Practice Address - Street 2:VILLA DEL REY
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6325
Practice Address - Country:US
Practice Address - Phone:787-743-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#2231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR64015Medicare ID - Type Unspecified