Provider Demographics
NPI:1528243656
Name:GARCIA MALDONADO, MIOSOTIS (MD)
Entity type:Individual
Prefix:DR
First Name:MIOSOTIS
Middle Name:
Last Name:GARCIA MALDONADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIOSOTIS
Other - Middle Name:
Other - Last Name:GARCIA MALDONADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:120 AVE CHARDON
Mailing Address - Street 2:COND QUANTUM METROCENTER APT4
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1721
Mailing Address - Country:US
Mailing Address - Phone:787-717-6136
Mailing Address - Fax:
Practice Address - Street 1:300 CALLE MANUEL DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3509
Practice Address - Country:US
Practice Address - Phone:787-765-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25704 R207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology