Provider Demographics
NPI:1932861838
Name:MALDONADO SOLER, JOSE RAFAEL (MD COUNSELING PSYC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:RAFAEL
Last Name:MALDONADO SOLER
Suffix:
Gender:M
Credentials:MD COUNSELING PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA ESPANA
Mailing Address - Street 2:CALLE LAS MERCEDES P58
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7330
Mailing Address - Country:US
Mailing Address - Phone:787-938-1184
Mailing Address - Fax:
Practice Address - Street 1:CARR 833 KM 12.2 BARRIO SANTA ROSA III
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-435-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6817103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling