Provider Demographics
NPI:1992751135
Name:MALDONADO-VIANA, JOY MARA (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:MARA
Last Name:MALDONADO-VIANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 SW 34TH CIRCLE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6616
Mailing Address - Country:US
Mailing Address - Phone:352-401-7575
Mailing Address - Fax:352-291-0231
Practice Address - Street 1:3305 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6616
Practice Address - Country:US
Practice Address - Phone:352-401-7575
Practice Address - Fax:352-401-7575
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256090900Medicaid
FL44571AMedicare ID - Type Unspecified
FL256090900Medicaid