Provider Demographics
NPI:1972707081
Name:MALDONADO, JOSE DAVID (EMT)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DAVID
Last Name:MALDONADO
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BDA COLL Y TOSTE
Mailing Address - Street 2:EDF-3 APT-12
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-380-0978
Mailing Address - Fax:
Practice Address - Street 1:BDA COLL Y TOSTE EDIFICIO-3
Practice Address - Street 2:APARTAMENTO -12
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-380-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR748-B146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic