Provider Demographics
NPI:1174520605
Name:MALDONADO TORRES, ISMAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:
Last Name:MALDONADO TORRES
Suffix:
Gender:M
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:PO BOX 801425
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1425
Mailing Address - Country:US
Mailing Address - Phone:787-645-3405
Mailing Address - Fax:
Practice Address - Street 1:EUGENIO MARIA DE HOSTOS STREET #18
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-845-7492
Practice Address - Fax:787-845-4933
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-31340Medicare UPIN
PR80176Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER