Provider Demographics
NPI:1972295665
Name:MALDONADO, DEVORA I
Entity type:Individual
Prefix:
First Name:DEVORA
Middle Name:
Last Name:MALDONADO
Suffix:I
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 1:223 S DATE ST W
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4331
Mailing Address - Country:US
Mailing Address - Phone:714-722-9370
Mailing Address - Fax:
Practice Address - Street 1:223 S DATE ST W
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4331
Practice Address - Country:US
Practice Address - Phone:714-722-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst