1003999194 NPI number — MR. CARLOS I MALDONADO ACEVEDO SR. MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003999194 NPI number — MR. CARLOS I MALDONADO ACEVEDO SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALDONADO ACEVEDO
Provider First Name:
CARLOS
Provider Middle Name:
I
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003999194
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#499 CAMINO DE CAMBALACHE
Provider Second Line Business Mailing Address:
SABANERA
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-598-6353
Provider Business Mailing Address Fax Number:
787-765-2841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE GENERAL VALERO 1020 URG LAS DELICIAS
Provider Second Line Business Practice Location Address:
RIO PIEDRAS
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-282-6534
Provider Business Practice Location Address Fax Number:
787-765-2841
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  8615 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500066E . This is a "MMM HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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