Provider Demographics
NPI:1932778214
Name:MALDONADO, ANA LAURA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:LAURA
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 1:300 W OLMOS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1958
Mailing Address - Country:US
Mailing Address - Phone:210-829-1705
Mailing Address - Fax:210-829-0162
Practice Address - Street 1:300 W OLMOS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1958
Practice Address - Country:US
Practice Address - Phone:210-829-1705
Practice Address - Fax:210-829-0162
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist